(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The nature and treatment of dropsy : considered especially in reference to the diseases of the internal organs of the body which most commonly produce it. Parts I. and II. Anasarca and ascites. To which is added, an appendix, containing a translation of the work of Dr. Geromini, on dropsy: from the original Italian"

Dulce University .Medical Center Library 
Trent Collection 



Bedford Purchase 



Digitized by the Internet Archive 
in 2013 



http://archive.org/details/naturetreatmentoOOseym 



THE 



NATURE AND TREATMENT 

OF 

DROPSY: 

CONSIDERED ESPECIALLY IN REFERENCE TO THE 

DISEASES OF THE INTERNAL ORGANS OF THE BODY 

WHICH MOST COMMONLY TRODUCE IT. 



PARTS I. AND II. 

ANASARCA AND ASCITES. 



TO WHICH IS ADDED, 
CONTAINING A TRANSLATION OF THE WORK OF 

DR. GEROMINI, ON DROPSY : 

FROM THE ORIGINAL ITALIAN. 



By EDWARD J. SEYMOUR, M.D. 

PHYSICIAN TO ST. GEORGE'S HOSPITAL; 
CONSULTING PHYSICIAN TO THE SEAMAN'S HOSPITAL; 
AND ONE OF THE PHYSICIANS IN ORDINARY TO H. R. H. THE DUKE OF SUSSEX. 



LONDON 

LONGMAN, REES, ORME, BROWN, GREEN, and LONGMAN, 

PATERNOSTER ROW. 

1837. 




LONDON : 
Wtlson and Son, Printers, 
57, Skinner-Street, 




TO 

SIR BENJAMIN BRODIE, Bart. F.R.S. 



SURGEON TO ST. GEORGE'S HOSPITAL, 

AND 

SERJEANT SURGEON TO THE KING, 

THE FOLLOWING PAGES ARE INSCRIBED, 

IN ADMIRATION OF HIS GREAT TALENTS, AMIABLE CHARACTER, 
AND UNWEARIED ENDEAVOURS TO PROMOTE EVERY 
IMPROVEMENT IN MEDICAL SCIENCE, 

AND 

IN GRATITUDE FOR AN UNINTERRUPTED FRIENDSHIP OF MANY 
YEARS' DURATION. 



CONTENTS. 



PART I. 

Anasarca, or Dropsy of the Skin 

Chap. I. 

The proximate or immediate Cause of Dropsy . 

Chap. II. 

Anasarca from Rheumatic Disease of the Heart. 



Chap. III. 
Anasarca from Enlargement of the Heart 



Chap. IV. 

Cases of Anasarca occurring without organic Disease 
of an internal Organ — 

1. From Cold applied to the Body 

2. After Eruptive Diseases, especially Scarlatina 

3. From Debility in young Females, with Sup- 
pression of the Catamenia, or succeeding to 
very large Discharges of Blood after Child- 
birth, or from Accident 



Vi CONTEXTS. 

ClIAP. V. 

Anasarca from Disease of the Kidneys 



Page 

n 



PART II. 

Ascites, or Dropsy of the Abdomen — 

1. From Contraction of the Liver after Inflamma- 



tion, &c m 

2. From Diseases of the Viscera supervening upon 
Ague 97 

Chap. VI. 

Ascites from Disease of the Peritoneum 101 



APPENDIX. 

ON THE CAUSES AND CURE OF DROPSY, 

From the Original Italian of Dr. F. C. GEROMINL 



Chap. T. 

Of the Theories of Physicians to the time of Brown, 
respecting the Causes which produce Dropsies ; and 
also those of the great Anatomists who have illus- 
trated (the structure and functions of) the Lymphatic 



System 115 

Chap. II. 

Of the sensible and well-known processes which pro- 
duce an effect similar to Dropsy 135 



CONTENTS. \ii 

Chap. III. 

Page 

Of the Diseases which frequently precede and generate 
Dropsy 138 

Chap. IV. 

Examination of the nature of the Fluid of Dropsy, and 
also of that which is naturally exhaled into the diffe- 
rent cavities ; afterwards of the Organic Alterations 
discovered in Dropsies 148 

Chap. V. 

Of the Method of Cure pursued in all times, although 
not always in accordance with the different Theories 
of the Schools 161 

Chap. VI. 

Explanation of the Cause of Dropsy, taken from the 
preceding Chapters 169 

Chap. VIII*. 

On the false opinions commonly put forward, from 
errors of observation on the remote causes of Dropsy 173 

Chap. IX. 

Examination of the thirst and wasting which accom- 
pany Dropsy 184 



* The Seventh Chapter is omitted, as consisting entirely of arguments 
against the Brunonian theory. 



Mil 



CONTEXTS. 



Ch\p. X. 

Page 

Explanation of the cure of Dropsy, derived from the 
reasoning in the preceding Chapter : reflections on 
that proposed by Cullen, by Milman, by Darwin, by 
Rasori; and examination of the " modus operandi" 
of remedies to promote it 194 

Chap. XI. 



The indications of the cure of Dropsy, derived fiom the 
opinions lately explained 210 



ON DROPSY, 



PART I. 



ANASARCA, OR DROPSY OF THE SKIN. 



There is perhaps no disease upon which Patho- 
logical Anatomy has thrown more light than 
upon Dropsy. This disease is now generally 
admitted, in its severest forms, to be a symptom 
of organic disease of one or more viscera of the 
body, in most instances arising from the return 
of blood to the right side of the heart being ob- 
structed, and the impaired functions of that 
organ being relieved by the secretion of large 
quantities of fluid ; the effusion being partial 
where the obstruction is partial, but where the 
obstruction is in the heart itself, sooner or later 
extending through the whole cellular texture. 
The ancient physicians, from their ignorance of 
anatomy, had contracted opinions that the liver 
was the principal agent in the formation of the 
blood, and hence to its disease all cases of dropsy 
were to be attributed : and when this idea dis- 
appeared before a more perfect knowledge of the 



2 



structure of the human body, each sect of physi- 
cians adopted some peculiar tenets of the school 
to which they belonged, to explain the causes of 
this fatal disease. These opinions will be found 
treated of at large in the Appendix, from the 
Italian of M. Geromini, who has investigated 
what may be called the history of the doctrines 
concerning dropsy, with singular labour, talent, 
and spirit: and as it is my wish rather to clear 
away than overload, I shall proceed directly to 
the object I have in view, — the arrangement, 
as far as it is possible, of these collections of fluid 
under their primary cause — disease of one or 
more of the viscera of the body. 

It will be well first to glance at the ordi- 
nary manner in which most frequently cases of 
dropsy present themselves in hospital and private 
practice, which wi 11 demonstrate the necessity of 
the more detailed consideration of them. 

How often does not the following case occur : 

A patient, between twenty and thirty, or 
younger, applies for relief, having difficulty of 
breathing, increased on ascending a stair, or on 
rapid motion, with constant palpitation of the 
heart : he will relate that he has suffered from this 
palpitation for several years, on any hurry, but that 
latterly it has become constant ; that he lies down 



3 



in bed with difficulty*, and that latterly his ankles 
and legs have begun to swell ; he has constant 
thirst ; the urine is high coloured; there is short 
dry cough, though he can inspire freely; his 
nights are restless ; and when he wakes, his eye- 
lids and cheeks are swollen : the pulse may be 
either quick and weak, or full and soft — rarely 
hard ; the urine, on examination, does not coagu- - 
late by the admixture of acids, or by heat. 

If further inquiry be made of the patient, he 
will be found to have been affected at some re- 
mote period, perhaps three or four years since, 
by acute rheumatism, with redness, swelling, and 
pain of the muscles and joints of the hands and 
feet, shifting their position from limb to limb, with 
fever; to have recovered from the attack, suffer- 
ing more or less from palpitation ; and to have 
become greatly alarmed at the recent appearance 
of the swelling : on listening to the chest, a noise 
resembling the blowing of bellows may be heard ; 
the heart is felt beating over a large surface, and 
the dress worn about the throat is perceived to be 
agitated by the increased action of the organ. 

The disease is enlargement of the heart after 
adhesion of the pericardium. The effusion or 
dropsy, in this case anasarca, is the consequence of 

* This symptom is not constant. 



4 



the disease having advanced so far that the heart 
is unable to circulate its blood freely. 

A man in the lower class of life seeks admis- 
sion into a hospital under the following circum- 
stances : — He is enormously swollen ; the face, 
hands, legs, and integuments of the abdomen, 
hard, but retaining the impression of the finger ; 
there is considerable difficulty of breathing, and 
hard dry cough ; sometimes a little expectoration, 
frothy and tinged with blood ; the urine is 
scanty, and does not coagulate by the usual 
methods; the pulse is hard, sometimes full ; the 
heart is felt beating over a large surface ; the 
tongue is often foul. 

The disease is recent, and the patient still 
strong, but greatly oppressed. 

If such a case prove fatal, the heart is found to 
be greatly enlarged ; its parietes, especially 
those of the left ventricle and the septum, double 
their natural thickness, and the cavities likewise 
enlarged, but not in proportion to the increase 
of the muscular structure. 

This is a case of enlargement of the heart from 
hard living, especially from drinking large quan- 
tities of porter. The patient is generally under 
fifty years of age. The dropsy is anasarca. 



6 



A woman, between 40 and 50, also applies 
for relief, with inordinate swelling of the whole 
body ; but here the surface is not only distended 
and white, but the impression of the finger re- 
mains at considerable depth in the integuments : 
the pulse is quick and feeble, and even where 
there is volume it is easily compressible; but it 
is irregular, and there often is a grating sensation 
communicated to the finger. The urine is small 
in quantity, not very high coloured, but incoagu- 
lable by heat or acid. There is great difficulty of 
breathing, and often cough, with much mucous 
expectoration. The labia are enormously dis- 
tended, and the parietes of the abdomen so much 
enlarged from infiltration, that, at first sight, 
ascites, or dropsy of the belly, would appear to 
be complicated with anasarca, but on striking 
the abdomen this is not found to be the case. 

If this case prove fatal, the heart will be found 
greatly enlarged, but not in its muscular struc- 
ture, or at least not in proportion to the size of 
the cavities ; the enlargement arising from dila- 
tation of the cavities, often also the valves do not 
shut perfectly from deposition of bone, and 
complicated with this is a dilatation of the root 
of the aorta, with atheromatous deposit. 

This case of dropsy, then, depends on the 
disease of the heart, with dilatation of its cavities. 



6 



In all these cases there is a greater or less 
degree of congestion or condensation of the 
lungs. In the first case, from the disturbed cir- 
culation ; in the second, from the action of the 
same intemperance which produced the disease 
of the heart ; in the last case, infiltration of the 
cellular structure of the lungs is also present. 

A patient, probably a young person, applies 
for relief, with swelling of the lower extremities 
and of the face ; the pulse is not weak \ there is 
pain in the back, sometimes in either hypochon- 
drium, and headache; no enlargement of the heart 
is perceptible ; no violent palpitation ; no move- 
ment over a large surface ; thirst ; no dyspnoea ; 
the urine is abundant and pale coloured, but on 
applying heat, or on the admixture of acid, a 
coagulation, varying from flocculi to nearly per- 
fect coagulation, takes place. 

If the patient die, the heart will be found na- 
tural, but the kidneys diseased. 

This, then, is dropsy from disease of the kid- 
neys. 

These are cases of dropsy from disease of a 
single structure ; but the causes which produced 
them, especially the inordinate use of stimulating 
liquors, may affect more than one. All the symp- 



7 



toms of dropsy from disease of the heart, with 
coagulable urine (or disease of the kidney), and 
with ascites from disease of the liver, may be pre- 
sent. Such cases are to be considered afterwards. 
By separating* the cases of one form of dropsy 
from disease of a single organ, as it has occurred 
to me frequently to have seen them, from more 
complicated ones, we shall be better able to con- 
template the history and treatment of those un- 
fortunate cases in which universal dropsy takes 
place, as a symptom of the organic disease of 
several viscera. 

In the following chapter I shall proceed to en- 
deavour to explain more fully how the diseases 
of these viscera individually produce certain forms 
of dropsy, and the comparatively rare cases of ' 
dropsy from functional disease. 



8 



CHAPTER I. 

The proximate or immediate cause of dropsy 
appears to consist in the secretion of fluid by the 
capillary arteries, nearly resembling the serum 
of the blood, more or less diluted, and in some in- 
stances approaching very nearly in consistence to 
the liquid secretion of lymph, which takes place 
at the conclusion, and is one of the terminations, 
of serous inflammation. Dropsies are generally 
considered under the head of — 

Anasarca, or dropsy of the cellular membrane ; 

Ascites, or dropsy of the peritoneal sac ; 

Hydrothorax, or effusion of fluid into the cavity 
of the pleura? ; and Hydrops Pericardii, from 
effusion into the cavity of the pericardium ; 

Hydrocephalus, or effusion of fluid into the 
ventricles of the brain. 

Anasarca arises most frequently — 

1. From disease of the heart. 

2. From disease of the heart and lungs. 

3. From disease of the kidneys. 



9 



These are the organs which, being diseased 
either separately or together, are accompanied by 
an effusion of fluid, which appears to relieve the 
severity of the original disease at some period of 
its progress. 

There is likewise a certain condition of the 
vessels of the skin (after cold suddenly applied to 
the surface of the body, or after the vessels of the 
skin have been long stimulated during eruptive 
diseases), in which the capillary arteries secrete 
a fluid precisely similar to that which is poured 
out as a relief to the congested vessels, in the 
organic diseases to which we have referred. 

The simplest form of dropsy of the cellular 
membrane, is the swelling of a limb,, or the 
extremity of a limb, without redness or heat, 
the part retaining, in a greater or less degree, 
the print of the finger impressed upon it, and 
the skin being white and shining : this is termed 
oedema. 

This oedema is found to depend either upon 
tumours pressing upon the veins above the swell- 
ing, or obstruction of the vein itself. The first 
occurs, for example, in one leg, in ovarian dis- 
ease, accordingly as the tumour within the pelvis 
obstructs the return of blood through the iliac 
veins, the minuter arteries secreting fluid, which 



10 



relieves the local congestion : if the tumour 
change its place, or the pressure be relieved by 
a horizontal position, the oedema disappears, or 
is greatly diminished. 

The oedema which takes place from inflam- 
mation and consequent obstruction to a vein, is 
seen in the legs after lying-in, in the arm after 
phlebitis from bleeding, and often in a single ex- 
tremity in those diseases termed malignant, or of 
a cancerous kind ; where, on examination after 
death, the vein will be found obliterated above 
the swelling, often from a deposition of matter 
not unlike what is found in the diseased mass, 
the cause of the patient's death. 

In every one of these cases the oedema is a 
symptom. 

Wherever great obstruction exists to the re- 
turn of blood to the right side of the heart, it 
would be fair to conjecture, from what we see in 
oedema in a single limb, that the whole venous 
circulation would be congested, and hence the 
whole capillary arterial system would secrete 
fluid, as a relief to the obstruction ; and if this did 
not occur, the balance of the circulation would 
be in so disturbed a state as to cause rupture of 
vessels in some vital structure ; and this we find 
to be the case : the capillary arteries pour out 



11 



fluid into the cellular membrane, of greater or 
less quantity, according" as the obstruction is con- 
siderable, and of greater or less consistence as the 
patient's vital powers are greater or less, or the 
obstruction more or less sudden. 

The oedema, in the first case, becomes now 
termed anasarca, or dropsy of the skin ; the 
swelling is generally more in the legs, from their 
depending position, but the eyelids, cheeks, and 
integuments of the abdomen, are often greatly 
swollen, especially after sleep in a recumbent 
position. If the swelling pitted deeply on pres- 
sure, the skin being very white, and the forces 
of the patient broken, this condition was called by 
the ancients Leucophlegmasia ; where the swell- - 
ing was more tense and resistent, and strength 
less impaired, they employed the name Ana- 
sarca. As these are shades of the same dis- 
ease only, I shall, for simplicity's sake, employ 
the latter term, as applicable to the whole 
disease. 

Anasarca, then, is only a symptom of disease of 
an internal organ, with the exception hereafter 
to be more minutely described, in which the 
capillary vessels of the skin take on inflamma- 
tory action after cold rapidly applied. I shall 
proceed to shew, that in the majority of cases 
this form of dropsy depends on a disease of the 



12 



heart ; reserving the cases of exception and their 
application afterwards. In these cases the heart 
is enlarged, sometimes with increase, sometimes 
with diminution of the thickness of its parietes. 
In such cases, when the valves are not diseased, 
the pulse is increased in frequency, and some- 
times, not always, in force, and the heart is 
felt beating over a large surface. Such is ge- 
nerally the case in anasarca in young persons, 
in consequence of enlargement of the organ, 
subsequent to rheumatic inflammation, and ad- 
hesion of the pericardium. In anasarca from 
enlargement of the heart, at a more advanced 
period of life, the valves are also frequently 
diseased : if the semilunar valves be the struc- 
ture principally altered, the pulse at the wrist is 
smaller, while the heart beats turbulently and over 
a large surface in the thorax ; if the mitral valves 
be diseased, there is more or less of a grating sen- 
sation communicated to the finger on applying it 
to the pulse at the wrist, and in either case the 
pulse intermits. The same occurs as to the grating 
sensation, when the heart is enlarged, and very 
considerable alteration of the lining membrane of 
the aorta above the semilunar valves, with dilata- 
tion of that tube, is found ; atheromatous deposit 
under the lining membrane, with portions of bone 
being also found on dissection. In both cases, but 
more especially the latter, the patient is subject 
to very severe paroxysms of pain, lasting for the 



J3 



space of some minutes, hours, or even days, but 
alternating with intervals of perfect ease. 

It is very remarkable, that disease of an artery 
may take place to a very great extent without 
dropsy occurring"; while enlargement of the 
heart, unless death occur suddenly previously 
to the obstruction of the return of blood to 
the right side being considerable, is usually at- 
tended with dropsy during some portion of its 
progress. The effusion may indeed be got rid 
of by remedies, and the organs of the body, ac- 
customed to the increased action, and greatly 
lowered in tone, still perform their functions, 
without a return of dropsy ; but in such an in- 
stance frequently a few months only elapse before 
death, generally sudden, terminates the case. 

The circumstance that the great arteries may 
be diseased to almost any extent, without drop- 
sical effusion, while the heart, much enlarged, has 
its oppressed functions relieved by effusion, is of 
considerable advantage in diagnosis of diseases 
of this important viscus. The following is an 
example : — 

A patient in St. George's Hospital laboured 
under considerable pain in the region of the heart, 
without expectoration, and with only short dry 
cough, ability to fill his lungs fully on inspira- 



14 



tion, and without pain. On inspecting- the thorax, 
the heart was observed to beat very quickly, and 
somewhat strongly ; its rapid motion being vi- 
sible in the epigastrium, while the pulse in the 
brachial arteries was small, and there was no 
dropsy, neither had there been any effusion 
during- the course of the malady. The ex- 
tremely rapid and not weak action of the 
heart, combined with the weak pulse, appeared 
to me to denote that the heart was endeavour- 
ing to overcome some considerable obstruction 
to the circulation of the blood; produced by a 
tumour pressing upon the aorta, or by an 
aneurism. The case attracted considerable atten- 
tion, and many gentlemen examined the chest very 
accurately; all believed the heart to be greatly 
enlarged, though much difference of opinion ex- 
isted as to the presence of aneurism. My opinion 
was decided as to the absence of any except 
inconsiderable disease of the heart, because I had 
never seen a case with so much disturbance in 
the action of that viscus, arising from enlarge- 
ment, without a greater or less degree of anasarca 
of the lower extremities. 

About a year after the patient had been in the 
hospital, absorption of the ribs, at the posterior 
part of the thorax on the left side, took place ; 
and a large aneurismal tumour appeared, which, 
after death, was found to have arisen in the de- 



15 



scend nig* aorta, and to have caused absorption of 
the bodies of several of the dorsal vertebrae, but 
the heart was in an entirely natural condition.* 

* As such a case is somewhat uncommon, I subjoin an 
accurate account of the post-mortem appearances, drawn up 
at the time by Mr. Caesar Hawkins, Surgeon to St. George's 
Horpital. 

The descending aorta was enlarged into an aneurismal sac, 
commencing about an inch below the left subclavian artery, 
and terminating close above the diaphragm, the communica- 
tion between the aneurism and each extremity of the sound 
vessel being abrupt, and somewhat valvular by the projection 
of the sac at each end beyond the part, which was still of its 
natural size. This sac extended across the back part of the 
left side of the chest to the ribs, three of which were completely 
broken up into several portions, which were loose in coagula 
of blood ; and another rib above and below these was carious, 
and partly dead, but not broken into separate pieces. The 
sac of the aneurism projected beyond the broken ribs, forming 
a considerable tumour behind the chest, and having the latis- 
simus dorsi muscle in contact with it. On the right side of 
the chest, the aneurismal sac projected about three inches be- 
yond the vertebras, but did not reach the ribs. The front of 
the aneurism had the oesophagus in contact with it, and the sac 
was partly indented and divided into two portions by this 
tube ; the pericardium and part of the right lung were also 
adherent to the sac, and on the left side the lung was in part 
adherent to the sac in the same manner, but appeared also in 
part to have been absorbed, so that the sac was in a measure 
formed by condensed lung, where the pleurae were thus defi- 
cient. On cutting into the aneurism from the chest, it was 
found to contain chiefly recently formed coagula, but towards 
the left side, where the ribs had been destroyed, there was a 
good deal of solid coagulum in layers of some standing. On 
emptying out the recent coagulum, several of the dorsal ver- 
tebrae were seen to be extensively absorbed, and their surface 



16 



The dropsy which occasionally occurs in chlo- 
rotic females may be add need as an exception ; 
but, upon examination, it will be seen, that the 
languid condition of the heart's action from want 
of power gives rise to precisely the same condi- 
tion, functionally, but in an inferior degree, to 
what arises from organic disease in the former 
instance. The heart is unable to impel the blood 
to the extremities, and the capillary veins neither 
receive nor transmit the blood with the same 
rapidity as in a state of health. Congestion 
of the venous system ensues ; hence oedema of 
the ankles and legs, puffiness of the face, diffi- 
culty of breathing : symptoms which are removed 
by permanently increasing the heart's action by 
steel, and all the usual means of promoting the 

exceedingly irregular and knotty,, this appearance arising in 
part from the destruction of the bone and intervertebral sub- 
stance, but in part also from the deposit of new bone on the 
exposed surface of the old. 

The lungs were full of dark blood and frothy fluid, and 
there was a considerable quantity of bloody serum in both 
pleurae and in the pericardium. The heart was slightly en- 
larged, the left side being a little thickened, while the cavities 
of the right side were enlarged, without any increase of mus- 
cular substance. 

The ascending aorta was very much dilated, and its coats a 
little altered in structure ; the centre of the anterior part of 
the sac of the aneurism was at the same time seen to be formed 
of the remains of the descending aorta, which was a good deal 
loaded with steatomatous deposit, the rest of the sac being 
composed of cellular structure, which had no definite separa- 
tion from that part which was formed of the artery itself. 



17 



growth of the body — as exercise without fatigue, 
dry air, animal food, &c. The same condition 
arises after profuse bleedings or haemorrhage. 
The obstruction of the circulation of the blood 
through the minuter branches of the pulmonary 
artery by disease, causes an inferior degree of 
congestion in the whole venous system. This is 
seen in cases of solidified lungs, either the result 
of inflammation, or obstruction from tubercles. 
The anasarca in this case is not so general as in 
diseases of the heart, for a portion of the blood 
still undergoes, from the extreme minuteness of 
the ramifications of the artery, the usual change; 
the alteration also has been slow, and the declin- 
ing strength of the individual, from the injury of 
this important viscus, has enabled, in some de- 
gree, parts to accommodate themselves to the 
change; i. e. the blood is in less quantity, and the 
obstruction less considerable and sudden, than 
after enlargement of the heart itself : hence the 
dropsy is less severe, being confined to some de- 
grees of oedema of the lower extremities for the 
general dropsy, and effusion of fluid into the chest. 

When the heart is enlarged, with disease of 
the valves, anasarca is often present to a great 
degree, and the obstruction to the passage of 
blood through the aorta causes it to be thrown 
back on the pulmonary veins, and large quanti- 
ties of fluid are secreted, to remedy this important 
congestion. To this the patient probably owes 

c 



18 



his life, or at least the continuance of life during 
some considerable time ; for without it, it is pro- 
bable some of the larger branches of the pulmo- 
nary veins would give way, and the patient die 
of haemorrhage. 

Where the obstruction has continued, and the 
consequent effusion has been considerable for 
some time, the right cavities of the heart become 
enlarged ; and at length the smaller vessels in 
the lungs pour out blood, often in large spots, 
to which condition the name of pulmonary apo- 
plexy has been given, very improperly. In every 
case, well marked, of this disease, which has 
fallen under my observation, the mitral valves 
have been most extensively and chronically dis- 
eased ; and in the beautiful plate by M. Cruvel- 
hier, the disease of this valve is prominently 
displayed, as the cause of so extensive and fatal 
an alteration of structure in the lungs. 

In many cases of extensive disease of the lungs, 
however, no dropsy is found. How is this to be 
explained ? In such cases, expectoration takes 
place in a very copious degree ; and this secretion 
constantly removed,, and passing away from the 
mucous membrane, or from a false membrane in 
a vomica, affords the relief more safely to the 
congested circulation of the patient, than that 
which is effected by the effusion into the serous 



19 



cavities, or the cellular membrane in other 
cases*. 

In these instances, therefore — consolidation of 
the lungs, by inflammation, or crops of tubercles — 
the oedema is only a symptom ; and the same 
may be said to be the case of the hydrothorax 
occurring* with extensive disease of the valves of 
the heart. 

Frequent as is anasarca from diseases of the 
heart, (enlargement with adherent pericardium, 
after rheumatic inflammation in early life, and 
enlargement with deposition of bone in the 
valves, coronary arteries, or pericardium at the 
root of the aorta in more advanced age), cases of 
anasarca undoubtedly occur, independently of 
disease of this important organ, or of the lungs. 
This leads us to consider the two forms in which 
the vessels of the skin may secrete fluid, after 
causes applied, which produce inflammation. 

(Cases from disease of the Kidney, afterwards 
to be noticed.) 

These are : — 

1. Anasarca from cold suddenly applied to the 
surface of the body. 

2. Anasarca succeeding to eruptive fevers. 

* In cases also of solidified lung from tubercles, even where 
the expectoration is not considerable, diarrhoea or colliquative 
sweats being often present, relieve the obstruction. 



20 



1st. After cokl applied suddenly to the surface 
of the body, dropsy not un frequently appears, 
J and this without organic disease. It is suffi- 
cient to remember the extreme vascularity of the 
cutis, the extensive secretion of perspiration over 
the whole extent, the quantity of imperceptible 
halitus or perspiration from the surface of the 
body, amounting, in the best chemical and phi- 
losophical estimate, to twenty-eight ounces in the 
twenty-four hours, to judge that the impression 
of cold suddenly applied, checking this necessary 
secretion, would produce great mischief : the 
consequence would necessarily be, either inflam- 
mation of the vessels themselves, causing a secre- 
tion of lymph ; or this process would be counter- 
acted by an increased degree of secretion, or 
exhalation, in other parts of the body. And 
what in fact do we find to be the case ? Most 
frequently when cold is suddenly applied to the 
surface of the body, diarrhoea is the consequence ; 
increased secretion and exhalation is formed in 
the intestinal canal, and thus the repressed sen- 
sible or insensible perspiration is balanced, and 
no dropsy takes place. After cold suddenly ap- 
plied, diarrhoea is common, dropsy rare • because 
the repression of the discharge from one mucous 
membrane is compensated by the secretion from 
another : and it is only when this fails to relieve, 
that this kind of dropsy takes place. Ordinary 
fluids failing to be secreted, which it is the fane- 



21 



tion of these vessels to prepare, and no increased 
secretion taking* place from the membrane, the 
relation of whose properties with the mem- 
brane covering- the body is so considerable, the 
vessels secrete lymph, the whole cellular mem- 
brane becomes distended, and the swelling* is less 
elastic, more resisting, the skin more stretched 
and shining-, than in the cases where a slow 
relief is afforded to the obstructed venous circu- 
lation. The action of the heart and arteries is 
increased in force and frequency; the secretion 
of urine is diminished, and high coloured ; the 
tongue is white ; in fact, a feverish condition of 
the body is formed ; blood drawn from the arm 
shews the buffy coat ; there is intolerable thirst 
present ; and the remedies, both indicated and 
effectual, are those which diminish the increased 
action of the heart and arteries, and control the 
secretion of coagulable lymph, viz. blood-letting 
and mercury. 

In physics, it is sufficient for a cause to pro- 
duce a given effect, and it is unphilosophical to 
seek for more than one given effect to proceed 
from a given cause. But widely different is the 
effect of any given cause upon a body composed 
of different structures, endowed with different 
degrees of vitality, and with different functions 
to perform ; and it is the absence of this consi- 
deration which has made physicians resolve, that 



22 



a cause, absolutely, singly, and solely, can pro- 
duce diseased function of vessels by inflamma- 
tion, and inflammation alone. Thus Geromini 
and his followers have advocated the point, that as 
in inflammation of serous membranes, the vessels 
pour out lymph under an aggravated form of 
the disease, and fluid in a less intense degree of 
inflammation, as a blister, for instance, applied 
to the skin, causes an effusion of fluid, more or 
less approaching to lymph, from the inflamed 
vessels, this process is the sole one to which 
dropsy can be attributed ; and hence that (which 
is the unfortunate deduction) to remedies for 
acute inflammation can its successful cure alone 
be attributed. 

That capillary vessels in serous membranes, 
destined apparently to secrete a halitus, in order 
to lubricate the opposing surfaces, (Cotunnius 
long since proved by experiments on living ani- 
mals, that this halitus did not coagulate ; hence 
the fluid of dropsy is not the condensation of 
this exhalation, as was formerly supposed, but 
a new secretion,) secrete lymph or whey-co- 
loured serum at the conclusion of inflammation, 
by which the tension and increased action of these 
vessels is relieved, is certain. That these vessels 
should not likewise secrete fluid, when the circu- 
lation is greatly obstructed, to relieve the con- 
gestion of the veins, appears to me altogether 



23 



hypothetical. If, indeed, a morbid effect could 
arise from one cause, and from that cause alone, 
the conclusion would be determined. But with- 
out entering' into hypothetical considerations, it 
is certain that one and the same effect to all ap- 
pearance, as far as the effusion of fluid is con- 
cerned, may be produced,, by disease of the heart, 
by obstruction to the circulation in the lung's, 
by cold suddenly applied to the surface of the 
body, by disease of the kidneys, and by eruptive 
diseases; but the exciting cause need not neces- 
sarily be the same. 



24 



CHAPTER II. 

ANASARCA, FROM RHEUMATIC DISEASE OF THE 
HEART. 

The subjects of this disease are generally young, 
and, with few exceptions, under forty years of 
age. It has occurred to me to see this disease in 
patients of nine years of age* : and the most se- 
vere case I ever saw, that in which the disorgani- 
zation of the heart had proceeded to the greatest 
extent, terminated fatally at the age of thirteen. 

A patient labouring under anasarca from rheu- 
matic disease of the heart, has swelling of the 
cellular membrane, having begun about the 
ankles : the face is also swelled, especially the 
eye-lids; there is an expression of anxiety, even 
greater than in diseases of the chest in general ; 
the pulse is generally small and quick, sometimes 
intermitting, but very small compared with the 
action going on within the thorax ; a tumultuous 
beating of the whole organ : this smallness of 
the pulse compared with the violence of the 

* A patient, in St. George's Hospital, suffered from rheumatic 
pericarditis at the early age of four years. 



25 



action in the heart itself, arises from the inordi- 
nate growth of the organ, without a correspond- 
ing enlargement of the vessels of the heart. In 
the most remarkable case of this kind I ever saw, 
the patient had laboured under the symptoms 
during four years, having commenced at nine 
years of age. The heart was enlarged to three 
or four times its natural size at his death, with re- 
peated layers of lymph glueing together the peri- 
cardium : the aorta retaining' the size of that vessel 
in a young boy of nine years. I have seen the 
same effect produced in adults,, from contraction 
of the aorta above the semilunar valves. If the 
anasarca be very considerable, there is little pain 
felt in the chest, the obstructed circulation being 
relieved by the pouring out of the secretion from 
the minuter vessels. If the effusion be only 
commencing, there is almost always pain in the 
region of the heart, often pain in the course of 
the biceps muscle of the left arm, and cramps in 
the legs : the patient is unable to lie down, and 
the most easy position is bending forward over 
the back of a chair. There is also in the early, 
stage a disposition to syncope. 

If the effusion has taken place for some weeks, 
the pain and disturbance in the chest are less 
felt, and the patient attributes all his sufferings 
to the dropsy. The legs are tense ; the face 
swelled, and of a pale bluish tint; great difficulty 



26 



of breathing ; the urine very scanty and high 
coloured, and where unaccompanied by disease 
of the kidney, does not coagulate by the usual 
method ; the pulse quick and weak ; the surface of 
the body cold ; there is present a short dry cough 
without expectoration, or with a very slight frothy 
expectoration, occasionally tinged with blood. 

When a patient applies for relief, labouring 
under these symptoms, the first question to be 
asked is, — Have you suffered from rheumatism ? 
or rather, as rheumatism in its ordinary sense is 
understood to apply to pains of all sorts, — Have 
you suffered from redness, swelling, and pain, in 
the limbs, confining you to bed ? The answer is 
generally —About a year ago ; or sometimes, two 
years ago. Occasionally the patient has experi- 
enced repeated attacks, or one very severe attack 
has preceded the symptoms by a few months. 

In such cases the pathological appearances are 
uniformly, enlargement of the heart itself; the 
parietes thickened, especially those of the left 
side, and the cavities also larger than natural ; 
the enlargement, however, not being in propor- 
tion to the increase in thickness of the walls of 
the heart; the pericardium is glued together by 
layers of lymph, often of old formation, and 
even organized, rarely (when life is terminated 
by dropsy) very recent. 



27 



In the notes of thirty cases, which I have seen 
in St. George's Hospital and the Seamen's Hos- 
pital, tog-ether with some in private,, these patho- 
logical appearances have never failed to occur in 
a single case. In all such instances the account 
of the rheumatic fever which had occurred at a 
greater or less distance of time previously, was 
clear, distinct, and well ascertained. This form of 
dropsy from disease of the heart is perhaps the 
simplest view of the cause and effect ; because it ' 
occurs in young people, before excess in the use of 
ardent spirits, or exposure to great changes of 
temperature, (the fruitful sources of diseases 
of the viscera), or before the advance of time has 
begun to injure the soundness of internal organs. 
Where diseases of the heart, terminating in ana- 
sarca, arise from the immoderate use of malt 
liquor, or ardent spirits, the same cause produces 
diseases of the liver, of the lungs, and often dis- 
ease of the kidneys ; and the anasarca is accom- 
panied with ascites, and with all the evils of a 
digestion nearly destroyed. But in anasarca after 
rheumatism, the viscera are generally unim- 
paired ; the alteration in the structure of the 
heart being the sole cause of the disease, which, 
from its striking appearance and distressing 
nature, is immediately looked upon as the prin- 
cipal one. 

The prognosis of anasarca from rheumatic 



28 



disease of the heart, is always unfavourable ; but 
it is to be remarked, that the disease is often 
more chronic, even in its most severe forms,, than 
dropsy from disease of the heart arising* from 
other causes. 1st, Because the disease frequently 
occurs in young persons ; and if the severity of 
it be relieved in the first instance, the growth of 
the chest enables the impaired action to be better 
borne. Thus I have seen the disease, in a most 
• severe form, endure during five years. 2dly, Be- 
cause not being the result of excess, spirit-drink- 
ing, &c. other organs have not suffered from a 
similar cause, as is so frequently the case in 
anasarca after such indulgences. 

The treatment of anasarca from this disease of 
the heart, varies according to the degree of inflam- 
mation of the pericardium going on at the time 
of the effusion : if it has been immediately pre- 
ceded by pain in the organ, and some swelling*, 
redness, or pain in the limbs, inflammatory action 
undoubtedly exists, and the means to relieve it 
must be had recourse to. Blood-letting, not in 
any large quantities, and taken from the patient 
when lying in a horizontal posture, so as to re- 
lieve the organ, without producing fainting, (for 
it is to be remembered, if the patient faints he 
may not recover,) is the first remedy. To this 
should succeed the employment of calomel and 
opium, (than which no remedy, it is well known, 



29 



is more successful in arresting the progress of 
inflammation of serous membranes.) Three grains 
of calomel and a quarter of a grain of opium may 
be given every four hours : a blister may be ap- 
plied over the region of the heart, and a strictly 
low diet enjoined. 

It may here be remarked, that the quantity of 
mercury which may be administered with the 
greatest advantage, in this state of disease, (when 
inflammation ending in deposition of lymph is 
going on in the pericardium), is almost incon- 
ceivable to those who have not witnessed it, 
without affecting the gums, or producing any 
inconvenience whatever. It has occurred to me 
repeatedly to see from fifteen to twenty grains, 
in the acute form, given during ten days or a 
fortnight, without any affection of the gums, or 
any appreciable effect, except the relief of the k 
symptoms : the breathing being improved, the 
anasarca disappearing, the sleep tranquil, and 
the pulse being restored to its regularity. 

In this form of the disease, where blood-letting 
is useful, and calomel and opium most efficient 
in restraining the action of the minute vessels, 
the most useful diuretic, in my experience, is 
nitre : from ten to fifteen grains may be given 
in mint-water, twice daily. The quantity of 
urine secreted under this course, is sometimes 



30 



very great, and with the most manifest relief to 
the patient. The preparations of colchicum in 
dropsy arising" from enlargement of the heart, 
the consequence of rheumatic disease, would na- 
turally, both from their presumed specific power 
in rheumatism, and also from their diuretic 
effect, appear to be indicated, but I cannot speak 
favourably of their employment : on the con- 
trary, great depression of vital power, with in- 
creased irregularity in the action of the heart, is 
often the consequence; and I do not remember 
any case in which benefit appeared to be derived 
from their employment. How unlike the effect 
produced by them in effusion into the joints, 
which caused them, under the name of Hermo- 
dactyls, to be termed by the ancients " Theriaca 
Articulorum !!!" 

The above treatment applies to the cases in 
which dropsy has appeared consequent upon en- 
largement of the heart from rheumatism ; the 
inflammation of the pericardium still going on 
in an inferior degree to that which originally 
existed. 

I proceed to notice the treatment where the 
inflammatory symptoms have ceased ; when the 
patient has for months laboured under effusion 
into the whole cellular structure of the body. 
The limbs, integuments of the abdomen, face, 



31 



and scrotum, are greatly swelled, the urine 
scanty and high-coloured ; there is great dysp- 
noea; the pulse full, but easily compressible; 
and the limbs, which in the former case were 
swelled and hard, admitting the print of the 
finger only on deep pressure, are lax, white, and 
receive deep indentation from slight pressure. 
Here the great object is to unload the system by 
diuresis, and thus to relieve urgent symptoms ; 
and here we may have recourse to the prepara- 
tions of digitalis with the happiest effect. 

Dr. Withering has remarked in the work which 
first formally introduced this medicine into prac- 
tice, that it will be found most effectual in a lax 
state of the system, where the effusion is consi- 
derable, and the action of the heart and arteries 
feeble; and this, in my experience, is uniformly 
the case. The infusion of digitalis is the prepa- 
ration most effectual as a diuretic, and it will, in 
the state of the system to which I have alluded, 
be found more frequently to succeed than any 
other. The formula which I have found more 
certain than any other, is the following : — 

R Infusi Digitalis, 3iv. 

Liquor. Oxymur. Hydrarg. 3ij. 
Aq. Menth. Sativ. 3viij. 

Tras. Oantharidis, tttxxx. M. Fiat haustus bis 
terve in die sumendus. 



32 



The Tinct. Cantharidis*, in itself an active diu-" 
retic, renders almost every other more effectual ; 
but it is contra-indicated in aged persons, where 
disease of the urinary organs is present. The 
rapidity with which the above draught operates, 
is quite astonishing: I have seen as much as a 
gallon and a half of urine voided in one night, 
after the second day of its employment. From 
the presence of the oxymuriate, however, it will 
sometimes purge — an effect to be prevented ; 
■ for this purpose, a pill, consisting of a grain of 
opium, should be given every night, at bed-time. 
It is obvious that the enlargement of the heart 
continues, when the dropsy which relieved the 
obstructed circulation is carried off by remedies, 
and that the patient has a crippled existence ; 
but in the more opulent classes of society, his 
life may be spared many years : not so with the 
poor man ; he must return to the rapid changes 
of temperature — the originally exciting cause of 
the disease — and to all those circumstances which 
especially influence the diseased organ, viz. 
toil, anxiety, vexation, and want. Hence the 
numerous and unhappy relapses which are seen 
in hospital practice. 

Anasarca, from the disease of the heart, also 

* This subject, and that of diuretics in general, will be dis- 
cussed in a subsequent chapter. 



33 



occurs from enlargement of this organ, from spirit- 
drinking, or the inordinate addiction to porter 
(common in this chy), or from long-continued 
anxiety, and great mental distress. In the first in- 
stance, the heart is much enlarged, principally 
with increased thickness of the parietes of the left 
ventricle, and the septum between the ventricles : 
it occurs from twenty years of age to sixty, and is 
almost invariably attributable to intemperance. 

The anasarca in this instance is enormous,, 
the whole cellular membrane of the body being 
greatly distended ; the integuments of the ab- 
domen being increased to a size which appears 
at first sight impossible, without effusion into the • 
abdominal cavity, and yet on striking the abdo- 
men no fluctuation is perceived. In extreme 
cases, the distention is so great that the cutis 
splits into laminoe, giving the appearance of fine 
threads, dividing its texture transversely ; at 
others, effusion takes place, in large blisters on 
the legs and extremities, which by bursting and 
discharging serum, for a time alleviate the dis- 
tress. The pulse is generally strong and quick, 
the urine seanty and high coloured, and does not 
coagulate by heat, or the admixture of acid ; the 
tongue is furred, the patient obliged to be raised 
in bed, and complaining of an insupportable 
oppression. The face is swollen, and often 
with a bluish tint, and there is constant thirst ; 

D 



34 



the bowels are generally natural in their func- 
tions, and the appetite little deranged. 

Now, where such a combination of symptoms 
from such a cause arises, it is natural to look for 
the most obvious relief ; and from the swelling 
and effusion occupying a continuous surface, to 
relieve it by scarifications ; and, in fact, this is 
for the time very effectual : an incision of about 
two inches, just above each inner ankle, will 
reduce in a few days the enormous effusion, and 
the consequent oppression of the patient. I have 
seen two gallons of fluid discharged in three days 
from such incisions, and the dropsy entirely re- 
- duced, but in almost every hospital case, erysi- 
pelas first, and subsequently gangrene, super- 
vened, and the patient died. Acupuncturation 
in dependent parts produces an inferior degree 
of relief, but with less danger — in hospital prac- 
tice at least : I have seen this operation followed 
by erysipelas and gangrene, although far less 
frequently than in the other more decided and 
effectual practice. 

Either of these modes of treatment, however, 
only relieves symptoms, and some remedy is ne- 
cessarily sought for, which, while it expels the 
fluid, by increasing the natural excretions, and 
thus effecting a vicarious drain, may diminish 
the increased force and violence of the heart's 



35 



action. The first of these is the elaterium : this 
very important medicine may be used where the 
strength is yet unbroken, however great may 
be the oppression from the extent of the ana- 
sarca, and the relief has often been so great and 
so permanent as to induce physicians to believe 
that not only has the fluid, the symptom of the 
disease, been got rid of, but that the actually 
increased bulk of the parietes of the heart is 
diminished. Bloodletting should be premised, 
both with a view of unloading the congested 
venous system, and of promoting absorption : (it is 
well known from the experiments of Magendie on 
the injection of poisons, that their operation was 
greatly quickened by premising bloodletting;) and 
afterwards the elaterium should be given in the 
following formula, beginning with half a grain : — 

R Elaterii*, gr. §. 
Subm. Hydr. 
Pulv. Capsici, aa. gr. ij. 

Conf. Ros. Canin. q. s. ut ft. pilula, mane sumenda. 

* It must observed, that the elaterium is most applicable in 
cases where the bodily powers are yet strong. Thus I was 
more successful in its use, in cases in the Seamen's Hospital, 
where the patients were hardened by exercise, and inured to 
exposure, than in St. George's Hospital, where many of the 
patients are from a class accustomed to long confinement and 
little exercise. Improperly administered, elaterium is apt to 
produce a diarrhoea, from which the patient never recovers. 

Dr. Cullen used very successfully three grains of gamboge 
with sugar, every three hours. Such practice, though it pro- 
duces frequent watery evacuations, is very inferior in power to 
the elaterium. 



36 



Such a form will operate very frequently by 
stool, producing many liquid evacuations, and 
accompanied for the most part by severe bilious 
vomiting", the effect of which, as is well known, 
is to produce a very active state of the absor- 
bents. Thus Forestus speaks of an ascites cured 
by sea-sickness; and the recession of tumours, 
under the action of vomiting*, has long" been 
ascertained. 

It is very remarkable how much oppression in 
such cases imitates true debility. 

It occurred to Dr. Chambers and myself to be 
called to a patient who laboured under enlarge- 
ment of the heart and great vessels : the effusion 
consequent on the former had been repeatedly 
removed by remedies, but had returned to so 
great a degree, that he had been three days in 
making a journey of sixty-five miles ; and his 
medical attendants had hesitated as to very small 
quantities of purgative medicine. On the even- 
ing of his arrival in London, he was bled, had 
his scrotum punctured, and took elaterium, which 
was repeated every alternate day for several 
weeks, with the decided advantage of undoubt- 
edly prolonging his life. 

When this remedy fails, or when it ceases to 
have the desired effect, I have succeeded in a 



37 



manner which has greatly pleased and surprised 
me, in evacuating the fluid by large doses of 
cream of tartar. Small doses of this salt are 
among the most popular remedies for dropsy, 
increasing the flow of urine, whether as a be- 
verage with lemon peel and ginger, under the 
name of Imperial, or with gin and sugar made 
into a kind of punch, whose diuretic properties 
are undoubted. But about seventy years since, 
Menghini, an Italian physician, recommended 
this medicine in far larger doses, as a deob- 
struentj and averred that he had cured many 
cases of dropsy by its exhibition*. 

* The principal cases related by Menghini, are those of 
ascites after diseases of the liver and spleen, maladies very 
common in Italy. The following, however, is one of the casea 
similar to those in which I have seen this remedy more effec- 
tual ; and it is also a good specimen of the manner in which 
these diseases are described. 

I have little doubt that the patient laboured under disease of 
the heart, with dilatation of the aorta, which gave rise to the 
" asthma primo convulsivum turn humorale," described in the 
case. 

" Invaserat mulierem quinquagenariam, biliosam, et habitus 
corporis macri, et rigidi, asthma primo convulsivum, turn 
humorale, cujus causa repetenda videtur a longiore mora in 
frigida, ut lintea lavaret. Cum hunc morbum plures menses 
tulisset, tandem die quarto Junii, annii 1755, se in Nosocomium 
recepit. Quae emolliunt, incidunt, et urinas blande proliciunt 
mensem unum fuerunt utiliter adhibita. At decrescente pau- 
latim respirandi lahore, aggrediebatur sensim cedema primo 
pedes, turn crura, deinde coxas postremo et faciem. Hae 
partes quin et abdomen sex dierum spatio, ob vesicam et 



38 



He recommended an ounce to be taken every 
morning in water ; the salt requiring about thirty 
parts of boiling water for its solution ; and states 
that patients recovered with the use of no other 
remedy : he adds, that the urine let fall a sabulous 
deposit at the time. Dr. Home, in his clinical ex- 
periments, has related a very large number of 
cases cured by Menghini's method. But as the 
organic disease is very different in different cases, 
as a glance at the histories will determine, no 
scientific deduction can be drawn as to which 
kind of dropsy, or to what disease of organ, the 
remedy is especially applicable. 

The tartaric acid, united with an alkaline base, 
has always been considered, for reasons which I 
am unable to explain, especially applicable in dis- 

alvum segnius fluentem supra modum tumuerunt. Hinc Sitis 
non modica, vigilia, cibi fastidium. .Venter, tametsi summopere 
distentus, percussus tamen aquam intus absconditam non 
accusabat. 

" Cum heec sic essent, spem non levem habui de Tartaro : 
quam auxit turn celer corporis totius tumiditas, turn conjectura 
de aquae absentia in ventris cavitate. Jam ergo non quem- 
admodum alias tartari drachmas quatuor, sed binae tantum sin- 
gulo die dantur. Arbitratus quippe sum remedium licet par- 
cius, tempestive tamen datum eodem liberalius_, ut serius 
dato, plus profecturum. Et sane res bene cessit, nam alvo 
prompte et pluries obsequente, et urinis crassis, sabulosis 
et ad uncias aliquando octoginta fluentibus, universus corporis 
tumor dierum quindecem spatio, nullo superstite, respirationis 
vitio, omnino desedit." — Vincent. Menghini Institute Bononi- 
ensi. Vol. iv. page 277. 



39 



eases of the liver. The tart, potassae especially 
was considered as a deobstruent in bilious ob- * 
structions, and the sulphate of potash in glan- 
dular obstructions : hence for ascites depending 
on disease of the liver, it would be reasonable to 
choose this remedy; but, in my experience, it is 
in anasarca from disease of the heart that this 
method proposed by Menghini is most effectual. 
I have repeatedly succeeded, even where ela- 
terium has failed in removing the dropsical effu- 
sion, by this method. An ounce of cream of 
tartar is directed to be taken every morning in 
solution, or if this acts too violently by stool, 
half an ounce will be sufficient. After the fourth 
day its beneficial effects generally commence. 



40 



CHAPTER III. 

The next case of anasarca from disease of the 
heart, is where this organ is greatly increased in 
size, with attenuated parietes. Such cases occur 
in constitutions broken by habitual intemper- 
ance, or debilitated by affliction, long-continued 
anxiety, great watching, and sometimes after 
long-continued and profuse evacuations — more 
frequently in females than in males; and the 
1 disease is more common in advanced age than 
the other forms of anasarca from disease of the 
heart. 

The pulse is weak, often irregular ; at least, 
even where there is volume, it is very compres- 
sible. The anasarca, which is very extensive, 
takes more the form of what has been termed 
leucophlegmasia : the face is swelled, and of a 
ghastly white appearance, while the integuments 
pit on the slightest pressure. The effusion is 
always preceded by difficulty of breathing, espe- 
cially on any quick motion, by violent palpita- 
tion, and disposition to syncope. The difficulty 



41 



of breathing is not, as in the former instance, 
much relieved at first by the effusion ; for not 
unfrequently the cellular membrane connecting 
the lobules of the lungs is infiltrated also. 

It is in this form of dropsy that sudden death 
frequently occurs. The patient may be appa- 
rently doing well, the swellings gradually re- 
ceding, when a sudden return of effusion, either 
into the chest or pericardium, is followed by 
almost instant death. 

This form also is often complicated with di- 
latation of the arch of the aorta, and deposition 
of atheromatous matter with spicula of bone 
under the lining membrane. In such cases there 
are not only all the evils arising from oppression 
and distention present, but also paroxysms of most 
severe pain, similar to what is experienced in 
ossification of the coronary arteries, and is termed 
angina pectoris. 

It is in this form of the disease, where the tone 
of the system is much impaired, that the prepa- 
rations of digitalis as diuretics are most effec- 
tual ; and it is in their application to this con- 
dition,, that Dr. Withering' s original observations 
on the use of this medicine are borne out in their 
full force and accuracy. 



42 



" 1. It seldom succeeds (says Dr. Withering) 
in men of great natural strength, of tense fibre, 
of warm skin, of florid complexion, or in those 
with a tight and cordy pulse. 

" 2. If the belly in ascites be tense, hard, and 
circumscribed, or the limbs in anasarca solid 
and resisting, we have but little to hope. 

" 3. On the contrary, if the pulse be feeble 
and intermitting, the countenance pale, the lips 
livid, the skin cold, the swollen belly soft and 
fluctuating, or the anasarcous limbs readily pit- 
ting under the pressure of the finger, we may 
expect the diuretic effects to follow in a kindly 
manner. 

This medicine may be combined with squill 
and mercury, as in the pil. hydropica, (pil. hyd. 
gr. iij. ; scillse exsicc, pulv. fol. digitalis, aa. gr. i.) 
or in infusion with the liquor, oxymur. hydrarg. 
in mint water ; and if the patient labour under 
no disease of the bladder or urethra, with the 
tincture of cantharides. 

To the addition of this medicine the tincture 
of cantharides (as I have before hinted) to the 
infusions of digitalis, of spartium, or of pyrola 
umbellata, I am convinced, by repeated expe- 



43 



rience, the most complete diuretic effect is to be 
attributed. I had, indeed, read that Dr. Wells 
had succeeded in producing diuresis with the 
tincture of cantharides, in three cases out of 
five, in dropsy, with coagulable urine, but I 
was first led to employ the preparation after a 
consultation with Sir H. Halford, on a case of 
hydrocephalus. 

That experienced physician related two cases 
of this most fatal disease, which he had seen, 
after the stage of effusion was established, re- 
cover, in consequence of a very abundant diuresis 
ensuing* on the administration of the tincture of 
cantharides. Hence I added this preparation to 
the infusions of diuretic vegetables ; and have 
succeeded more uniformly in expelling- the fluid 
with the infusion of digitalis, combined with 
oxy muriate of mercury, with the addition of 
tincture of cantharides, than with any other diu- 
retic preparation I have used, or seen used, in 
my experience. 

This leads me to say a few words on the in- 
ternal use of this very important preparation, not 
only in this but in some other serious diseases. 

Cantharides have been recommended from very 
high antiquity, and have been employed, and 



44 



afterwards laid aside or neglected, partly from 
their irritating effects when they are incau- 
tiously exhibited, and partly from their partaking 
of the uncertainty of all diuretic medicines, (Dr. 
Wells's cases might well have awakened a spirit 
of inquiry,) partly because of the condemnation 
of Dr. Cullen, who says, " they failed certainly 
in the hands of Dr. Carmichael Smyth, who 
asserts that, in his frequent exhibition of the 
tincture of cantharides, he never once observed 
the secretion of urine increased.' * 

In modern practice they have been recom- 
mended by Cloqnet, who believes that in sub- 
stance the cantharides produce strangury, but in 
liquid are diuretic. In aged people, and those 
labouring under any disease of the prostate or 
of the mucous membrane of the bladder, I fear 
it will be found that in tincture, as well as in sub- 
stance, the cantharides produce this very painful 
consequence. 

It may be here permitted also to make a few 
short observations on the great influence which 
this medicine exercises over certain cases of 
paraplegia. 

I have succeeded beyond my hopes in restoring 
the use of the limbs in early life in this dreadful 



45 



disease. It has been long known to be useful in 
such cases; and in pressing it upon the consi- 
deration of the profession, I am advocating no 
very novel practice, though the successful cases 
are scattered though different works. In all the 
cases in which I have seen its administration 
effectual, it has acted as a powerful diuretic ; 
and if Dr. Baillie's opinion be correct as to one of 
the causes of this disease, (" if there be any 
effusion of serum between the membranes of the 
brain, which is a very common occurrence^ a 
portion of the serum may fall into the cavity of 
the theca vertebralis, and press upon the lower 
part of the spinal marrow,") this diuresis will 
sufficiently explain its utility in the palsy of the 
lower extremities. 

The following cases are remarkably striking 
ones : — 

William Mowland, set. 29, was admitted into 
St. George's Hospital, July 22, 1835, affected 
with palsy of the upper and lower extremities : 
two years before he had suffered from paralytic 
affection of the hands in a less degree. On ad- 
mission, he was unable to stand, or feed himself ; 
his intelligence was entire, but all movement of 
the extremities suspended ; the sensibility in the 
lower limbs was likewise impaired ; his appetite 
and digestion nearly natural \ he passed his stools 



46 



and urine at times involuntarily ; his sleep was 
much disturbed. Pulse 80 ; tongue clean. 

I ordered strips of blistering plaster to be ap- 
plied to the spine, and the vesicated surface to 
be dressed with mercurial ointment, being* the 
most effectual practice in palsy with which I was 
acquainted : his bowels were also ordered to be 
kept open. This treatment was repeated three 
times, and some increased degree of power over 
the lower extremities appeared to be the conse- 
quence ; but as the case did not progress, I re- 
quested a consultation with my friend and col- 
league, Dr. Chambers : it was agreed to give 
him the tincture of cantharides. 

On the 28th of August, thirty minims were 
ordered to be taken thrice daily, in water. 

In two months, during which the practice was 
never varied,, he recovered the entire power of his 
limbs, and the sensibility returned : the extensor 
muscles of the fore-arms alone remained disobe- 
dient to the will. (He had never worked in 
lead.) Splints were ordered for these. In four 
months from the beginning of the disease he was 
able to walk out, and to help himself, weakness 
only of the extensor muscles remaining: at this 
time a slight strangury came on ; and it is re- 
markable that this did not occur until the dis- 



47 



ease, for which the can tha rides was prescribed, 
had almost entirely ceased. Camphor, and the 
use of the warm hip-bath, relieved the symptoms. 
He remained in the hospital during" the winter, 
in order to test the permanency of his cure, and 
left it quite well in March 1836. 

Henry Mansell, a prize-fighter, set. 22, was ad- 
mitted, in the winter of 1834-5, into St. George's 
Hospital, after a pugilistic match, in a state 
which gave reason to believe he suffered from 
concussion of the brain. He recovered his senses, 
but remained paralytic of the hands and legs. 
He was unable to stand ; and in order to move 
from place to place, crawled forward, shoving 
himself onward with one leg, as children do 
when first learning to walk : the sensibility in the 
legs was almost destroyed. He was during some 
weeks under the care of Sir B. Brodie, who re- 
lieved the affection of the brain arising from the 
accident : subsequently he was transferred to my 
care. He had used full doses of strychnia with- 
out the least benefit : all the animal functions 
were natural, (pulse 60.) I ordered him to be 
cupped once in every fortnight, from the nape of 
the neck, and blisters to be applied in succession 
over the spine, and dressed with mercurial oint- 
ment. Great relief was afforded by this treat- 
ment : he recovered the use of his arms and 



48 



hands, and greatly increased power over the lower 
extremities. At this time I ordered him the 
tincture of cantharides, as in the former instance, 
and very rapid progress was made. In less 
than a month he was enabled to walk well on 
crutches ; and so satisfied was he with the hope 
of ultimate recovery, that he left the hospital at 
his own desire. 

The recovery in this instance was preceded 
by creeping pains along the course of the spine 
and in the limbs, occasionally very severe : they 
were relieved by the sp. ammon. succinat. in 
camphor mixture : these pains exactly resembled 
at times the aura epileptica. 

I have seen one more case recover under this 
treatment : and there is one other case now in 
the hospital, under the same course, with every 
prospect of success. 

MM. Merat and Lens, in their beautiful work 
on the Materia Medica, wind up their observa- 
tions by the following remark on cantharides, to 
the truth of which I entirely subscribe : — 

" Mais c'est en teinture surtout qu'elles sont 
bien indiquees : c'est dans ce cas un des moyens 
a la fois les plus efficaces, et compart a la phi- 



49 



part de ceux qu'on y emploie, les moius re- 
do ub tables*. 

The nitrate of potass in solution, in the dose of 
fifteen grains; the acet. of potass, in the dose 
of from one to two drachms, either in its usual 
form, or made by neutralizing in solution the 
carbonate of potass with the vinegar of squillsf ; 
may be given in a draught, with a pill, consist- 
ing of three grains of the blue pill, several times 
in the day ; or a kind of punch may be given, made 
with cream of tartar instead of lemons, to every 
pint of which two ounces of gin may be added : 
all these are very effectual diuretic drinks. The 
latter is very convenient in hospital practice. 

The spirit of nitric aether may be added, in 
the dose of a drachm, to a draught containing 
ten grains of nitre dissolved in mint-water; or 
it may be given as a beverage in the proportion 

* Dictionnaire de la Matiere Medicale ; Art. Meloe vesicator. 

-J- The following was a favourite prescription of the late Sir 
F. Milman : — 

R Aq. Menth. Virid. 3j. 
Aq. Purae, %ss. 
Carb. Potass, gr. xv. 
Aceti distill. 3vj. 

Aq. Pip. Jamaic., Syrupi, Aceti Scillae, aa. 3j. 
M. ft. haustus. 

E 



50 



of two drachms, or two drachms and a half of 
aether, in six ounces of water : in this latter form 
it is not disagreeable. 

The spirit of nitric aether, the compound 
spirits of horse-radish or juniper, can scarcely be 
given in sufficient quantity to have any decided 
effect ; but they may be used in private practice, 
as "adj n vandal 

As the disease advances, if no advantage be 
obtained from the remedies mentioned,, the pa- 
tient or his advisers seek, from the long list of diu- 
retic remedies, other means to get rid of the fluid. 

The preparations of squill, when combined 
with mercury, are better adapted to cases where 
blood-letting is necessary, because this medicine 
by its nauseating properties diminishes the force 
and power of the heart ; but in the case we are 
' considering, there is increased action with di- 
minished power. Dr. Withering recommends the 
employment of squill in those cases in which, 
from the strength of the pulse, the recent nature 
of the disease, and the youth of the patient, little 
is to be expected from the diuretic effects of digi- 
talis. Another difficulty presents itself in some 
cases — that extreme irritability of the stomach is 
induced, thus prohibiting the practitioner from 
the use of nearly all internal medicines. This 



51 



has not escaped the observation of the French and 
Italian physicians ; some of the latter, especially 
Brera and Chiarenti, recommend the employment 
of this remedy in friction, and speak of its decided 
success. I have employed this mode of administer- 
ing the squills in the wards of St. George's Hos- 
pital, and would speak with diffidence of the 
result of a very few cases in which it was ordered. 
Half an ounce of the dried powder of squills was 
mixed with double the quantity of hog's-lard, and 
a drachm rubbed in thrice daily over the abdomen 
and the inside of the thighs : this was only in cases 
in which the extreme irritability of the stomach 
prevented the administration of the ordinary 
preparations of this plant. Of the inunction of 
Veratria ointment, as recommended in recent 
publications, I have little experience; in the few 
cases in which I employed this most expensive 
remedy, no advantage was derived from its use. 

Of the hydriodate of potass as a diuretic, I can- - 
not speak favourably injny own experience; the 
value of this medicine, in another form of dropsy, 
will be referred to hereafter. 

The school of Montpellier long since exploded 
the popular, but most erroneous, doctrine, that 
drinking freely was injurious to dropsical pa- 
tients — an idea as old as those Grecian schools 
of physic which recommended spices and wine 



52 



as corroborants in this disease ; and sometimes 
exposed the patients to the ardent rays of a 
southern sun after covering- him with ointments 
made of honey, lees of wine, and other stimulant 
preparations, with a view of drying up the su- 
perabundant moisture. 

The most celebrated remedy for dropsy in France 
before the Revolution*, appeared to owe a large 
part of its efficacy at least to the copious draughts 
of weak beef-tea (bouillon) ordered during its ad- 
ministration. The pills themselves, each of which 
contained half a grain of a drastic purgative 
(the extract of black hellebore), were given six at 
a time, early in the morning, and repeated at mid- 
day, the patients drinking copiously during the 
operation ; but the author of this method, either 
unable to withstand the doctrines of the humoral 
pathologists with whom he was surrounded, or 
willing to persuade, rather than argue with the 
world at large, and their popular idea of debility, 
called his pills, the basis of which was a drastic 
purgative, increasing all the secretions, by the 
name of " Pilules Toniques." In my expe- 
rience, the pills of Bacher are infinitely inferior 
in power to elaterium. 

* Bacher's pills consist of half a grain of extr. hellebori nigri, 
half a grain of myrrh, and nearly half a grain of the powder of 
■ the card, benedictus : the infusion of the latter plant is a feeble 
bi\t popular diuretic. 



53 

It is now about twenty-five years since Dr. 
Somerville,sen.* made known generally the pow- 
erful effects of the pyrola umbellata as a diuretic. 
It has not been sufficiently employed to enable us 
to determine to what cases its administration is 
particularly adapted. In very languid cases of 
anasarca, where the swellings are of long stand- 
ing, and other remedies have failed, I have been 
agreeably surprised by seeing a full flow of urine 
established, and great relief afforded. It is best 
administered in infusion, an ounce of the leaves 
and stalks being infused in a pint of water, which 
should be drunk during the day. It sometimes irri- 
tates the urinary passages violently, and should 
therefore not be used in cases of advanced age, or 
where the patient has suffered from stricture. 

The infusion or decoction of the twigs and 
stems of the spartium scoparium has long been a 
remedy adopted in the country to produce diu- 
resis. It may be given in decoction, an ounce 
of the broom tops being boiled in a pint and a 
half of water to a pint, and mixed with an equal 
quantity of hot milk, or in infusion, as common 
tea. It has appeared to me to be more useful in 
the convalescence of patients than early in the dis- 
ease, keeping up a diuresis already established, and 
promoting the general strength of the patient. 



* In the Med. and Chir. Transactions. 



54 



Sydenham recommends the ashes of this plant 
dissolved in white wine; and, latterly, the seeds 
have been greatly recommended in Germany in 
similar cases, a drachm of them being taken 
twice daily in two ounces of white wine. I 
have only seen this remedy employed in two 
cases, and in both without the smallest effect. 

The allium sativum (garlic) has been very 
strongly recommended by the most competent 
• authorities in dropsy, especially in anasarcous 
swellings which accompanied asthmatic com- 
plaints, — cases in all probability arising from en- 
largement of the heart, with dilatation of the 
great vessels. 

Forestus, Sydenham, and Cnllen, all speak in 
the highest terms of this remedy. Two or three 
cloves are recommended to be swallowed several 
times in the day. It has occasionally in my ex- 
perience proved grateful to the stomach, but not 
effectual as a diuretic. 

The flowers and stalks of the apocynnm can- 
nabinum, or white hemp, were, a few years ago, 
recommended from America as a most powerful 
diuretic. I employed this herb in infusion in 
two cases of dropsy, in St. George's Hospital ; 
but it proved in both far inferior either to the 
digitalis or the pyrola, in promoting the flow of 



55 



urine, and in one case produced much distress 
and vomiting, with a weak and irregular pulse. 

The application of cabbage-leaves to the calves 
of the legs in anasarca, is sometimes attended 
with a considerable discharge of serum from the 
skin : the effect may be rendered more certain 
by rubbing the anasarcous legs gently with vo- 
latile liniment previous to the application of the 
leaves. 

Looking to the observation of several years in 
these cases, I should say by far the most effectual 
diuretics stand in the following order of utility: — 

Infusion of Digitalis with Tinct. Cantharid. 
Nitrate of Potass. 

Supertart. of Potassae with Sp. Juniper. C. 
Pil. Hydrarg. Pulv. Dig. et Scilloe exsice. ; 

in form of pill. 
Acet. et Tinct. Scillse. 
Infus. Pyrolee Umbellatae. 
Infus. Spartii. 
Sp. iEtheris Nitrici. 
Sp. Armoraciae Comp. 

If the swellings in such a case be of recent 
date, such means will often suffice to carry 
off the water by diuresis, and careful attention to 
the diet, which should be nutritious but not sti- 



56 



mulating, carriage exercise, pure air, and ab- 
stinence, as much as possible, from harassing 
and anxious occupations, will sometimes, for 
years,, prolong the patient's life ; but where the 
swellings are of many months continuance, little 
is to be expected except relief. Even here, life may 
be prolonged for a considerable time, under the 
most unfavourable circumstances, among the opu- 
lent. Not so with the poorer class of patients, 
in whom, in this country, intemperance has been 
the most active cause of their malady : when re- 
lieved of the fluid, which they consider to be the 
disease, they speedily return to spirit-drinking ; 
and if there be yet power in the system to se- 
crete a sufficient quantity of fluid, they are again 
affected by their former swellings. 

It sometimes happens that after a long and very 
unsatisfactory course of treatment, with little 
effect in reducing the swellings, and thus re- 
lieving the oppression of the patient, the fluid, 
after the administration of some trifling remedy, 
begins suddenly to subside, with a rapidity equally 
astonishing and cheering to the patient: his at- 
tention being always fixed upon the dropsy, the 
symptom of the disease, he feels delighted at 
getting rid of what he considers to be the whole 
malady. 

Such subsidence of the effusion in dropsy, un- 



57 



preceded by a gradually increased flow of urine, 
or by the use of remedies calculated to produce 
evacuations, and which by being administered 
during a long period, hinder, at least for a time, 
the re-collection of the fluid, is a very fatal symp- 
tom; the vital powers are no longer sufficiently 
strong to afford relief to the obstructed circula- 
tion, secretion from the smaller and more minute 
vessels no longer relieves the labouring heart. In 
several cases which have fallen under my observa- 
tion, the patient has never rallied after this sudden 
subsidence of the effusion beyond a month : but 
I have heard of life being prolonged somewhat 
longer. A case of this kind is to be found in 
the experience of the late Dr. Parry, of Bath*. 
In the hospital I have had several opportunities 
of pointing this out to the pupils. It is an addi- 
tional proof that dropsy is only a symptom., and 
for the time a relief: if the relief can no longer 
be afforded, from the diminished vital powers of 
the patient, he sinks, either apparently quite 
w 7 orn out, or from the rupture of a vessel within 
some important viscus — as the stomach, lungs, 
or brain. 

* * See Dr. Parry's Posthumous Works, page 191, vol. i. 



58 



CHAPTER IV. 

CASES OF ANASARCA OCCURRING WITHOUT OR- 
GANIC DISEASE OF AN INTERNAL ORGAN— 

1 . From Cold applied to the Body. 

2. After Eruptive Diseases, especially Scarlatina. 

3. From Debility in young Females, with Suppression 

of the Catamenia, or succeeding to very large 
Discharges of Blood after Child-birth, or from 
Accident. 



The first case, dropsy from sudden impression 
of cold, is not of very frequent occurrence. Cold 
and wet acting suddenly, or for a length of 
time, on the surface of the body, more frequently 
produce inflammation of internal viscera, as of 
the bowels or lungs, or diarrhoea ; but in some 
cases, after sudden exposure to cold and wet, the 
whole cellular membrane of the body becomes in- 
filtrated, the swelling is hard and tense, the pulse 
hard, the urine very scanty and incoagulable* by 
heat or acids, the heart beats without symptoms of 

* This is generally the case, but in some instances the urine 
coagulates slightly, a symptom which disappears by the treat- 
ment which relieves the dropsy. The coagulability of the urine 



59 



organic disease, though its action is increased, the 
bowels are costive, the effect likewise follows very 
rapidly on the cause applied ; the patient's health 
has been good. There is in this state a general 
feverish excitement ; the vessels of the skin, 
over the whole surface of the body, secrete 
serum, and the mucous membrane is deprived 
of the natural secretion which these vessels pour 
out in a state of health. 

The indications of cure are to diminish in- 
creased action, and to restore the secretions, espe- 
cially those of the mucous membrane of the 
bowels, both as revulsive and because of the 
great sympathy which exists between the mem- 
brane which covers, and the membrane which 
lines, the viscera of the body. 

The patient should immediately be bled, and 
the blood drawn in such cases is almost invari- 
ably, in my experience, buffed and cupped. The 
next most important remedy for inflammation, 
calomel and opium, should be resorted to ; three 
grains of the former, and one of the latter, being 
given morning and evening, and a saline draught 
three or four times in the day : every second 
morning the bowels should be freely opened with 

in such cases has not been accompanied by alteration in the 
specific gravity of this secretion, as in cases where the struc- 
ture of the kidney is diseased. 



60 



senna and crystals of tartar ; two ounces of the 
former dissolving about two drachms of the latter. 
The cure of this form of disease will generally be 
perfected in about ten days; but the patient 
should not be dismissed, or exposed to the air, 
thus early, but, as a matter of precaution, retained 
in the hospital, or confined to the house, a few 
days longer. 

The pathology* of the anasarca which suc- 
ceeds scarlet fever is not well understood"}*. 
That it is seldom fatal I am fully convinced, 
notwithstanding the observations of De Haen 
and othersj, and by comparing epidemics with 
those of former years, it appears to be far less 
frequent than formerly, as a consequence of 
dropsy. 

Various also have been the opinions of the 

* We need scarcely proceed further, to demonstrate the 
truth of this observation, than the opinion of Dr. Frank: — 

" Cette hydropisie aigu'e peut dependre d'un etat inflam- 
matoire manifeste, reliquat de la scarlatine, de la debilite\, ou 
elle laisse dans Peconomie de Pirritabilite excessive du 
sy steme lymphatique, et ineme de l'etat spasmodique de la peau ; 
enfin, des saburres ; mais le plus souvent de la suppression 
la transpiration."— P. Frank, Traite de la Pratique de Mede- 
cine, torn. ii. page 661. 

-j- Ex hoc consectareo plures morruntur quam ex morbo 
primacco. — De Meza, torn. i. 59. 

\ Plenciz and others. 



61 



treatment to prevent so unsightly and protracted 
a disease. The French and Italian physicians 
attribute its origin to the impression of cold air 
on the surface, and religiously keep the patient 
secluded in a closed apartment for forty days : 
should dropsy supervene, it is invariably attri- 
buted to some too slight observance of this rule. 

The cold practice in this disease, universally 
pursued in Britain, and which is rarely followed 
hy anasarca, is the best answer to such an expla- 
nation ; the same may be said of the opinions 
which attribute this form of disease exclusively 
to weakness. 

Almost all eruptive diseases are followed by a 
diarrhoea*, supposing a mild case little interfered 
with by remedies. Small-pox, measles, and scar- 
latina, frequently conclude with an attack of this 
nature. It appears to me that this points out 
the real condition of the disease: where saline 
purgatives are freely used throughout the dis- 
ease, the means are effected by which nature 
terminates the cure. I have seldom, if ever, seen 
the anasarca supervene where this class of re- 



* It is remarkable also, that an habitual diarrhoea suppressed 
will often be succeeded by anasarca. Several cases are re- 
lated in Portal's work Sur VHydropisie. 



62 



medies was freely used, especially towards the 
decline of the disease. 

There is a passage in the work of the late 
Dr. Hamilton, of Edinburgh*, on this subject, 
very striking, and which I have seen fully borne 
out in observations in various hospitals both at 
home and abroad. Now French and Italian 
physicians, as it is well known, employ purgative 
medicines in such diseases very sparingly; confin- 
ing themselves to the use of enemata, or the 
mildest purgatives : hence, in my opinion, the 
frequency of anasarca after scarlet fever, com- 
pared with the same in this country. 

It is fair, however, to say, that these views 
do not coincide with those of many old physi- 
cians. Dr. Willan says — 

" Practitioners in this country have generally 
" found the dropsical symptoms yield to diuretics, 
" combined with Peruvian bark, preparations of 
" iron, or calomel. I do not mean to infer that my 
iC countrymen are successful, in this stage of the 

* Dr. H. lost three patients in Heriot's Hospital, during an 
epidemic of scarlet fever, by the dropsy, which followed the 
disease. In the many cases which succeeded these, he em- 
< ployed purgatives fully at the decline of the fever, and in no 
instance did the dropsy occur. 



63 



" disease, by any peculiar practice. If they have 
" had more success in the treatment of scarla- 
" tina, than physicians on the continent, I would 
" ascribe it to the general disuse of bleeding and 
"purgatives during the last thirty or forty years, 
" within which period gangrene and dropsy have 
" been with us much less frequent occurrences 
" than formerly. " 

The dropsical swellings in every case attended 
by Dr. Rush, were removed by doses of calomel 
and opium. 

It is remarkable that dropsy by no means 
supervenes in proportion to the severity of the 
disease. A very slight febrile attack is some- 
times followed by it ; and I do not remember, 
among the very worst cases of a low type, to 
have ever seen one terminate in serous effusion. 

It is remarkable also that in the celebrated 
work of Dr. Fothergill on this disease,, no men- 
tion whatever is made of dropsy as a sequela of 
scarlatina maligna, in those who escaped the first 
severity of the disease. 

Though anasarca is by far the most frequent, 
and, in my opinion, the least formidable kind of 
dropsy which supervenes on scarlatina, ascites, 
hydrothorax, and hydrocephalus, also occur. It 



04 



is, however, to be remarked, that all these forms 
of dropsy are more tractable than in ordinary 
cases, because they are not dependent on disease 
of structure. I do not here, however, allude to 
the occasional occurrence of purulent effusion 
from inflammation of the serous membranes of the 
chest (empyema) ; happily a rare, but, I believe, 
always a fatal disease, when it occurs during the 
course or at the conclusion of scarlatina. 

The following case is illustrative of two 
points in the foregoing observations : that these 
effusions are by no means necessarily preceded 
by a severe form of scarlatina ; and secondly, 
that they are more curable than ordinary cases, 
because less frequently connected with structural 
disease of internal viscera. 

A married woman, aged thirty-six, was ad- 
mitted, some years ago, into St. George's Hos- 
pital, under my care, with a slight attack of scar- 
latina : the efflorescence was bright, continued 
three days; the throat was slightly ulcerated ; 
and the cuticle desquamated as usual. During 
the efflorescence she was sponged with cold 
water and vinegar ; the bowels were freely 
opened ; first, fomenting gargles, and subse- 
quently astringent ones, were used to the throat, 
and the case proceeded to convalescence readily. 
At the expiration of ten days she appeared to be 



65 



quite well, and remained only in tke hospital 
as a precaution against taking cold. About the 
fourteenth day from the commencement of the 
disease, she was suddenly attacked with pain in 
the head, loss of speech, followed by paralysis of 
the sphincters, dilatation of the pupil of the eye ; 
all which symptoms were formed in the course of 
a day and night. The pulse was quick and small, 
and there could be no doubt of effusion having 
taken place into the head. She was ordered to 
be bled to sixteen ounces ; two grains of calomel 
were put upon the tongue every three hours ; 
and a blister applied to the top of the head, and 
kept open with mercurial ointment ; half an ounce 
of the infusion of digitalis being put down the 
throat with a spoon, the intermediate four hours. 

Under this treatment she gradually recovered : 
first the involuntary discharges were repressed, 
consciousness returned, but the faculties of the 
mind remained in a very strange state. The 
patient was precisely in a similar condition to that 
of one who is recovering from a violent concus- 
sion of the brain. She understood all that was said 
to her, but could not remember the words to 
express her answer. Thus, when asked what 
o'clock it was, she explained herself by signs, 
not being able to remember the words : subse- 
quently she used words, single, and unconnected 

F 



66 



by articles, so as to express her meaning, but 
not in a sentence. By degrees this power of ex- 
pression returned \ she was quite well at the end 
of a month, and two years afterwards I again 
?aw her in perfect health. 

Anasarca, after scarlatina, begins generally 
from the fourteenth to the eighteenth day after 
the commencement of the disease — sometimes 
gradually, sometimes within the space of a very 
few hours ; the patient is enormously swollen, so 
that the eyes are closed ; the countenance white, 
shining, and swollen to an enormous extent ; the 
secretion of urine of a deep colour, and in very 
small quantity. In many instances the urine is 
mixed with blood, and in such cases coagulates. 
(See a paper by Dr. Wells, in the first vol. of 
the Transactions of a Society for the Improve- 
ment of Medical and Chirurgical Knowledge.) 
There is thirst, a furred tongue, and even, on the 
onset, heat of skin • sometimes, but rarely, diffi- 
culty of breathing and headache : the integuments 
of the abdomen as well as the scrotum, and the 
rest of the cellular membrane of the body, are 
anasarcous in the highest degree. 

If the preceding fever has been slight, and the 
forces of the patient little broken, and espe- 
cially if it has been thought unnecessary to purge 



67 



in the disease, and no diarrhoea has supervened,* 
blood-letting" should not be omitted ; the patient 
should be freely purged with calomel, followed 
by senna, with crystals of tartar, and this re- 
peated every alternate day ; and (for it is difficult 
with a child to get much medicine taken) a beve- 
rage of half an ounce of sp. setheris nitrici in half a 
pint or a pint of water, with a small proportion 
of syrup, taken in the day. 

Sometimes instead of the senna a tea-spoonful 
of an electuary composed of jalap two drachms, 
supert. potassas half an ounce, honey half an 
ounce, may be given in the morning* succeeding 1 
the administration of the calomel with the best 
effect. 

But assuming that the little patient is weakly, 
that the forces are much broken by previous de- 
licate health, and a severe attack of illness, it 
will be necessary to have recourse to diuretics — 
either the combination of digitalis with a bitter, 
or some of the bitter diuretic infusions. The in- 
fusion of digitalis and the infusion of gentian 

* It is well known that Sydenham recommends V. S. in the - 
diarrhoea after measles : the secretion from the vessels of the 
skin,, in scarlatina, where this natural evacuation has not oc- 
curred,, seems still more to require this remedy. 

" Quern et diarrhoea/' says Sydenham, " quam morbillis 
cxcipere diximus, vaenesectione panter sanatur." 



<J8 



have been recommended ; and I have seen, added 
to this, the best effect from a drachm of the 
liquor potassae in every six ounces, composed of 
equal parts of infus. digit, and infus. genti- 
anae. In a few cases the decoction of the pyrola 
umbellata, to every pint of which half a drachm 
of the tinct. of lyttee has been added, (two ounces 
taken every four hours), has succeeded in reliev- 
ing the disease, in a manner very striking to the 
bystanders. 

In no case, in my experience or observation,, 
has success followed on the use of tonics alone. 
It is probable that in many of these cases the 
use of the vapour bath would be a valuable ad- 
junct in promoting the cure, by inducing a more 
healthy action of the skin ; but it should by no 
means be employed without premising the use of 
the lancet. 

3. In chlorotic anasarca, or anasarca occurring 
after great loss of blood, a functional condition 
of the heart occurs not very dissimilar to what 
happens when the viscus is itself diseased in its 
structure. An enlarged and dilated heart does 
not circulate its blood to the extremities ; con- 
gestion of the venous system takes place ; a se- 
cretion from the minute arteries relieves this con- 
dition. Now in chlorosis there is a deficiency of 
red blood ; the heart makes up in frequency, in 



69 



very severe cases, what it wants in force, (the 
same occurs after great loss of blood — hence what 
is called the hemorrhagic pulse,) and the blood 
again shews a disposition to stagnate in the right 
side of the heart ; the ankles and legs swell, the 
face is puffy and white ; in slight cases the pulse 
is languid ; in severe ones, as we have said, rapid 
and very weak ; there is terrible palpitation on 
ascending a stair; the pulsation is communi- 
cated to the jugular veins, and there is much 
headache : but the treatment is widely different 
from that necessary in a case of organic disease ; 
the patient's strength in this instance must be 
built up, the injured organ is not be relieved 
from its oppression by evacuants, but stimulated 
gradually to circulate the blood more regularly, 
while nutrition affords this fluid of its natural 
and stimulating quality. 

That physician is the best in this instance who 
can introduce steel into the system without ex- 
citing fever ; in severe cases, however, the patient 
will bear only the very mildest preparations. 

The ammoniated tincture, given in the dose of 
half a drachm to one drachm several times in the 
day, will be generally borne; when, however, 
it produces much headache, the cure should be 
commenced by ammonia, aether, or the foetid 



70 



gums ;* after a short time steel will be borne, 
and in another week, the most effectual, in my 
experience, of all the preparations of steel, the 
mist, ferri comp. will be taken in the dose of an 
ounce, gradually increased to two ounces, twice 
in the day, with the most decided benefit. To 
this must be added, if possible, horseback ex- 
ercise, and pure dry air ; first the lightest, and 
then the most nutritious animal food should be 
administeredf : in this way all the symptoms will 
gradually disappear ; the oedema first, and then the 
difficulty of breathing ; the palpitation, so long 
felt and so alarming, will occur but seldom, and 
finally not at all. The catamenia will be re- 
gular, the pain in the left hypochondrium (some- 
times in both hypochondria) will be no longer 
troublesome, and complete recovery established. 

Yet such a course as this, where the anasarca 
arises from an enlarged and dilated heart, would 
undoubtedly destroy the patient : fortunately, 

* R Sp. Aramon. Succin. ttlxvj. 
Mist. Camphorse, 3iss. M. 
Ft. haustus bis terve in die sumend. 

R. Sp. Amnion, foetid, ttjxvj. 
Mist. ( amphora;, oiss. M. 
Ft. haustus. 

•j- The bowels should be kept open with the aloes and myrrh 
pill, or equal parts of ext. colocynth c. and pil. galbani comp. 



71 



generally speaking*, the diseases are not frequent 
at the same age, chlorotic anasarca being exclu- 
sively a disease of youth, and anasarca after great 
evacuations, following on a well-known and 
ascertained cause; while anasarca from passive 
diseases of the structure of the heart is usually 
an occurrence at a later period of life, and its ex- 
citing causes, as fright — intemperance, anxiety, 
or excessive fatigue — are also pretty generally 
apparent. 



72 



CHAPTER V. 

ANASARCA FROM DISEASE OF THE KIDNEYS. 



That the kidneys are frequently diseased, as a 
cause of dropsy, is a modern discovery, which 
we owe to the patient investigation and sagacity 
of Dr. Richard Bright; and subsequent autho- 
rities have confirmed the fact, that the disease of 
these organs is always accompanied by a greater 
or less degree of coagulability of the urine, ac- 
cording as a greater or less degree of alteration of 
the structure of the kidneys exists — from perfect 
granulation, as pointed out by Dr. Bright, to 
simple engorgement. 

The specific gravity of the urine is also always 
less than in healthy urine, and there is often a 
deficiency of urea in it. 

The observations of Dr. Bright have been cor- 
roborated in an excellent paper by Dr. Chris- 
tison, and afterwards by Dr. Gregory, in the 
Edinburgh Medical and Surgical Journal ; while 



73 



the method of treatment has been more especially 
pointed out by Dr. Osborne, of Dublin, in his 
recent very able work on Dropsies, principally in 
illustration of this form of disease. 

Dr. Christison has left little to wish for in his 
very complete paper on the symptoms and patho- 
logy of this disease ; and states (a fact repeated 
by Dr. Gregory) that, in every fatal case in 
which coagulability of the urine, with a low 
specific gravity, existed before death, the disease 
pointed out by Dr. Bright was found to exist, on 
the post-mortem examination ; thus fully and 
powerfully corroborating the statement of the 
latter physician. Dr. Osborne repeats the same 
result from his experience ; and in the wards of 
St. George's Hospital I have watched this test 
during many years; invariably finding, where 
cases with coagulable urine and low specific 
gravity proved fatal, that the kidneys presented a 
fac-simile of the representation given of them in 
this disease by Dr. Bright, in his Hospital Reports. 

The urine* in this disease is sometimes scanty 

* " Of this state (dropsy) deficiency of urine is a usual 
but not a constant effect : for I have seen at least ten cases, at 
various ages, from fifteen to sixty, of dropsy, chiefly anasarca, 
ending in hydrothorax, in which the quantity of urine has spon- 
taneously been, from the beginning till two or three days before 
death, fully equal to that which was natural : as for example 



74 



and high coloured ; but in the worst cases the 
urine has been found to be pale and abundant, 
while the anasarca was general and to a great 
extent. In such cases the disease is very fatal \ 
and the condition of the kidney, its extensive 
disorganization and obstruction visible after 
death, explains the reason why anasarca, without 
any diminution of the secretion of the urine, was 
always looked upon as a condition of disease un- 
usually hopeless. 

The cases which have occurred in my prac- 
tice, where the urine was abundant and pale 
coloured, have all been in young subjects, from 
eighteen to twenty-five years of age : three of 
these cases occurred to me in the course of last 
year : in all of them the kidneys had reached 
the highest state of granulation. 

The coagulability of the urine after scarlatina, 
with admixture of blood, was noticed by Dr. 
Wells; and this peculiarity in the secretion 
formed a division in Dr. Blackall's work on 
Dropsies. That it occurs in dropsies from cold, 
in which an inflammatory state of the system 
exists, has been remarked, and is relieved by 

from two to four pints daily, clear and even so?neli?ties pale, 
and yet the patients have all died. Nay, I have never seen a 
patient recover under these circumstances of a natural state of 
urine." — Parry's Posl/nunous Works, vol. i. p. 192. 



75 



ordinary antiphlogistic treatment ; but it exists 
also in crises where long-continued organic dis- 
ease has broken the vital powers, and where, 
though inflammation may have been the cause of 
the destruction of the structures in the first in- 
stance, no inflammatory action any longer exists, 
and has been shewn, in every fatal instance, to 
have proceeded fron N disorganization of the 
kidney, and of the kidney alone. 

There is only one position on which I am in- 
clined to differ with the accomplished author of 
the Hospital Reports. Where disease of the liver, 
heart, and kidneys, exist in the same patients, 
Dr. Bright appears to believe that disease of 
the kidneys is the primary disease, and the dis- 
organization of the other important structures 
secondary. It is more clear to me, that the same 
cause, the abuse of ardent spirits, or long-continued 
and repeated exposure to cold, which has pro- 
duced disease in one vise us, has also affected the 
others. We know that disease of the liver and of the 
heart proceed from intemperance ; and instances 
are not wanting of disease of the kidney producing 
anasarca arising from this cause, and existing 
alone. One of the worst cases I ever saw, of 
anasarca with coagulable urine, was in a youth 
of nineteen, who had been addicted to the immo- 
derate use of spirits, rum principally, and no 
other viseus was diseased except the kidneys. 



76 



Again, how often do we not find, after hard 
drinking, enlargement of the heart and liver, 
accompanied by anasarca and ascites, while the 
kidneys remain perfectly sound? 

About half the cases of dropsy admitted into St. 
George's Hospital, in my experience, have coagu- 
lable urine : and in about one-third of such of these 
cases as have proved fatal, the kidney was the 
only viscus diseased : the other two-thirds had 
disease of the heart and liver in addition to gra- 
nulation of the kidneys. Of those cases of ana- 
sarca without coagulable urine which proved 
fatal, the heart was invariably greatly enlarged ; 
and these were often complicated with ascites 
from disease of the liver. 

When a patient presents himself for examina- 
tion with anasarca of the legs, thighs, and pa- 
rietes of the abdomen, of some weeks' duration, 
where no disturbance in the motion or regu- 
larity of the heart's action is to be perceived, 
and on testing the urine by heat, or the addition 
of a mineral acid, it coagulates strongly, we may 
safely conclude that disease of the kidneys is the 
organic cause of the dropsy : if the urine be 
scanty and high coloured, it is a relievable case ; 
if abundant and pale-coloured, one of deep 
anxiety. The skin is singularly pale and dry in 
this disease : and Dr. Bright has very fully ex- 



77 

emplified the fact, that persons labouring under 
it are subject to sudden inflammatory attacks of 
various viscera, and even of effusion into the 
ventricles of the brain. The principal indications 
of cure, then, are to get rid of the dropsy by such 
remedies as will alter the morbid condition of the 
urine; and, secondly, to remove any inflammatory 
attack which may arise in the course of treatment. 
Dr. Bright, and subsequently Dr. Osborne *, 
have laid great stress on the sympathy which 
exists between the skin and the kidneys, and re- 
commend every attention to restore the healthy 
secretion of this organ. The great relation which 
exists between these two secretions has long 
been observed, and indeed is obvious to the 
most careless observer in the ordinary functions 
of health : in disease, the same importance of 
the relation is still more obvious, nor can I in- 
stance it better than in the words of the cele- 
brated Dr. Mead : — 

" There is a great harmony between the 
kidneys and glands of the skin, so that the hu- 
mours brought on the latter easily find a way 

* On this point it would be quite unfair to quote single 
passages from Dr. Osborne. This physician tell us, and his 
evidence is quite worthy of confidence, that one-fourth of the 
cases, such as we have described, succeeded under his plan, 
" which never failed in removing this kind of general dropsy, 
whenever the surface of the body was restored to a per- 
spiring state.'* — See Osborne on Dropsies, p. 45. 

The whole work is well worthy an attentive perusal. 



78 



through the former, and are carried off by urine ; 
and on the other hand, when the kidneys have 
failed in the performance of their functions, an 
urinous humour perspires through the cuticular 
pores*. 

Dr. Wells cured three cases out of five, of ana- 
sarca with coagulable urine, with cantharides ; 
and Dr. Mead recommends them in lepra,, from 
their diuretic property. Dr. Bright states that he 
has succeeded with the cream of tartar in several 
instances, and I have found this medicine far 
more useful than any other in dropsy from 
disease of the kidney ; but looking" to the func- 
tions of the skin, I have employed also the 
vapour bath, using this remedy on alternate days. 
The perspiration excited by the vapour bath is 
excessive, and its use should be graduated to the 
patient's strength. I have found this remedy 
far superior to any internal one known to pro- 
duce diaphoresis. Where there is pain in the 
lumbar region, as not unfrequently occurs in an 
aggravated form of the disease, cupping is very 
useful, and every intercurrent inflammatory dis- 
ease I have been in the habit of treating exactly 
as if no dropsy had existed, according to the 
symptoms and locality — blisters only being ex- 
cepted, from their being often followed by ery- 
sipelas, and even sloughing. 



* Mead : Medica Sacra. 



79 



I have been careful, on a subject so extensive 
as the present, not to overload the observations 
I wish to lay before the profession with cases; 
my opinion is formed from the habitual observa- 
tion of them j but, except to illustrate a particular 
point, I have been desirous of leaving results to 
be considered alone. 

The following case of dropsy from disease of the 
kidney will best illustrate the mode of practice 
which I have found successful : — 

B. C, aet. 30, was admitted into St. George's 
Hospital under my care, March 80th in this 
year : she laboured under anasarca of six months* 
duration, affecting the lower extremities, inte- 
guments of the abdomen, and face. The heart 
and respiratory organs were natural in their 
action : pulse 84, and not weak ; the bowels 
confined. 

The bowels were opened by a dose of calomel, 
followed by senna and crystals of tartar, and she 
was ordered to be bled. 

The blood drawn shewed no inflammatory 
crust : the urine was of very low specific gravity, 
and coagulated into a solid mass by acids and 
heat ; it was very scanty and high coloured. 



80 



31st. She was ordered the vapour bath every 
alternate day ; was cupped on the loins ; and the 
diuretic mixture of infus. digitalis, liq. oxym. 
hydr., and tinct. canth. ordered, but it disagreed, 
making her feel sick : an ounce of supertartrate 
potass was ordered to be taken daily in solution. 

On the 6th, much perspiration was found to 
be produced by the bath. On the 12th, ana- 
sarca was greatly diminished, urine increased 
in quantity, and general health greatly improved. 
19th, The urine coagulated very slightly, either 
by acids or heat. 23d and 24th, Much pain was 
complained of in the head and left side, with 
spasmodic twitchings of the muscles ; the pulse 
was strong, and the skin warm : she was ordered 
to be bled, and calomel grs. ij.. and opium gr. §, 
given every third hour. The blood drawn was 
buffed and cupped. 

On the 28th, all these symptoms having dis- 
appeared,, the mercury was omitted, and the use 
of the cream of tartar resumed, with the bath. 

30th. She was without pain ; the urine was 
pale, abundant, and alkaline : pulse 80, and not 
strong ; the bath very agreeable to her. 

She appeared quite well, when, on the J 3th of 



81 



May, another inflammatory attack, apparently 
affecting the kidneys and bladder, took place : 
she was bled, (the blood was inflamed,) and ca- 
lomel and opium prescribed for two days : when 
the symptoms having* disappeared, she resumed 
the use of the bath and cream of tartar. 

On the 26th the dropsy had entirely disap- 
peared, the urine was natural in quantity and 
quality : she remained in the house until the 7th 
of June,, during" which time her appetite and 
the secretion of urine were perfectly natural, 
and she had regained her strength. 



82 



PART II. 

ASCITES, OR DROPSY OF THE ABDOMEN. 



Ascites, or dropsy of the peritoneal cavity, may 
arise, in an inferior degree, in either of the above- 
mentioned conditions of disease, in conjunction 
with anasarca from disease of the heart or disease 
of the kidneys. I believe, however, that where the 
kidneys alone are diseased as a cause of dropsy, 
ascites is not generally perceived, (such has been 
my experience) ; but any apparently increased 
bulk of the abdomen arises from anasarca (infil- 
tration of fluid) of the cellular membrane of the 
integuments. 

Where the heart is alone diseased, the collec- 
tion of fluid occasionally occurs in the peritoneal 
cavity, but it is subordinate, from its smaller quan- 
tity, in importance to that contained in the cellu- 
lar membrane. The circulation in the abdomen 
is peculiar : the greater quantity is expended in 
forming the important secretion of bile from the 
vena portee, and the remainder only is returned 
by the hepatic veins to the right side of the 



83 



heart. The obstruction therefore to the heart's 
action, arising* from enlargement or dispropor- 
tionate dilatation of the cavities of the organ, 
will affect the venous system in the abdomen far 
less than throughout the whole body : hence it 
is that anasarca is the most common form of 
dropsy attendant on disease of the heart, and 
where this important viscus is alone diseased, 
ascites scarcely appears. 

The principal cause of ascites, or dropsy of the 
abdomen, is disease of the liver ; and much spe- 
culation, especially of late years, has been em- 
ployed, to demonstrate that the disease of the 
liver, which precedes ascites, is always inflam- 
mation, and that it principally affects the serous 
coat. 

Formerly, enlargement of the liver was con- 
sidered as the cause of ascites, and the mecha- 
nical bulk of the viscus pressing on the vena 
portae as the cause of obstruction to the due cir- 
culation of the secreting fluid • hence thrown 
back on the capillary veins, and causing a corre- 
sponding exhalation of fluid from the exhalent 
arteries, to relieve the congested vessels, and 
maintain the balance of the circulation. 

Such a condition, however, does not occur, 



84 



except very rarely, as a cause of dropsy of the 
abdomen, and then only when the viscus is not 
simply enlarged, but indurated. Where the 
liver is enlarged by depositions of matter of a 
malignant nature, and known under the name 
of encephaloid tubercles, its size will often oc- 
cupy the whole abdomen, without any ascites 
being present. It has occurred to me to see a 
case, in which the liver measured sixteen inches 
in length and fourteen in breadth, occupying the 
w hole of the superficies of the abdominal cavity, 
excepting a small notch or space in the left iliac 
region, without any effusion of fluid whatsoever; 
there being, as it appeared, a sufficient interstitial 
quantity of the usual structure of the liver to 
permit the circulation necessary for its functions 
to be carried on. The most frequent appearance 
of disease of the liver, and that which is most ge- 
nerally connected with ascites, is characterized by 
diminution of the bulk of the viscus : the liver is 
about one-half its natural size, very hard, and 
with the sharp edge, so characteristic of it in a 
state of health, blunt and rounded. In post- 
mortem examinations, instead of finding it pro- 
truding into the belly, we seek for it under the 
ribs in the right hypochondrium, and find it 
there drawn up, as it would seem, from its dimi- 
nished size. The peritoneal coat is in such case 
most frequently found thickened : this not un- 



85 



usually takes place in parts; and this partial 
thickening gives to the viscus the appearance of 
being* puckered, not very unlike the lobulated 
structure of the calf's kidney. On cutting into 
these portions, the viscus itself does not present 
corresponding depressions, but the appearance 
arises from the membrane having been thickened 
in parts. Occasionally the whole peritoneal coat 
is thickened, of a milky white colour, and the 
viscus beneath contracted, extremely hard to the 
knife, and presenting a round almost globular 
mass when removed from the body. 

The consequence of this change is, the uniform 
pressure upon and obstruction of the minute and 
secreting branches of the vena portce : such an 
obstruction naturally throws back the blood upon 
the trunk of the vein * the capillary veins are 
congested, and the capillary arteries secrete 
fluid — not a transudation from their coats, as 
was conceived, but a secretion resembling the 
serum of the blood. 

This thickening of the peritoneal coat has 
made some authors suppose that inflammation of 
this covering alone is sufficient to produce the 
disease, and that it is never found where such 
marks of inflammatory action are absent : hence 
that dropsy is necessarily the result of inflamma- 
tion, and the deduction to be drawn is, that it 



is to be combated essentially by antiphlogistic 
remedies. 

But this is a mistake : inflammation of the 
peritoneal covering" of the liver, in common with 
other parts of the peritoneum, may exist to a 
great extent without dropsical effusion : and 
there is another condition of disease of the liver 
in which the peritoneal coat remains uninjured, 
where dropsy is equally the consequence, because 
uniform obstruction is presented to the extreme 
branches of the vena portae. 

In this instance, the secreting structure of the 
liver is nearly obstructed by the deposition of 
reddish-white substance, by some believed to be 
lymph, and the effect of inflammation, by others 
supposed to be cholesterine ; but in either case, 
on a section of the liver, the whole seems to be 
made up of rounded masses, which, in some in- 
stances, can be separated from the cellular mem- 
brane which connects them, but the change is 
uniform throughout the whole mass. In many 
such cases the peritoneal coat is quite clear and 
transparent, proving that causes exist, indepen- 
dent of its thickening, to produce such an ob- 
struction to the progress of the blood, as to act 
as the proximate cause of dropsy. 



But it will be asked, how does this explanation 



87 



agree with the cases in which the structure of 
the liver is wholly obliterated — in which the well- 
known secreting* parenchyma is changed into 
a fatty mass, or of a very pale yellow colour, or 
almost entirely composed of encephaloid tuber- 
cles, and yet there is no dropsy present ? 

That such cases have occurred there can be 
no doubt ; and it appears to me to be accounted 
for by the alteration in the circulating fluid itself : 
there is a degeneration of the whole body, the 
arteries do not secrete fluid, in order to keep 
up the balance of the circulation, impeded by 
the disease of the viscus ; but both solids and 
fluids undergo a degree of degeneration, and 
the whole system tends to decay. The ap- 
pearance of persons labouring under this form 
of disease confirms this idea; the countenance 
is of a waxy yellow colour ; no red blood ap- 
pears circulating on the surface ; the principal 
ailment complained of is excessive weakness, 
sinking, often without any local pain ; the pulse 
is weak, and about a hundred in a minute ; the 
patient is emaciated, and the muscles have lost 
their firmness and colour ; in blood drawn from 
the arm, the red particles are scanty, and the fibrin 
scarcely adheres ; a weakened state of the nutritive 
fluid, adapted to the weakened state of parts 
which act in the function of secretion, and both 
tending to the undoubted death of the patient. 



88 



I shall proceed, then, to speak of the most fre- 
quent, most obvious, and most invincible form of 
ascites, which arises, as has been before stated, 
from a contracted state of the liver, with a thick- 
ened peritoneal coat, or from a universal altera- 
tion of the secreting structure of the viscus, by 
the deposition of reddish-white matter; by some 
considered to be coagulable lymph, by others 
believed to be cholesterine, the peritoneal coat 
retaining in this case its transparent and healthy 
character. The first condition is undoubtedly 
produced by intemperance, especially in the use 
of spirits. The second case is less frequent, and 
I am inclined to believe often arises from (at least 
in three instances it could be traced to) indul- 
gence in the use of opium. 

The external appearance of a person labouring 
under ascites from either of these causes is in strik- 
ing contrast with those cases of anasarca which arise 
from disease of the heart. When some induration 
of the liver accompanies disease of the heart, both 
ascites and anasarca are present, but the abdo- 
minal effusion is small in quantity, compared 
with that which takes place in the cases I am 
attempting to describe : in the former, the in- 
crease of bulk is principally owing to infiltration 
of the cellular membrane connecting the muscles 
of the abdomen ; in the second, these muscles 
are wasted, the fat absorbed, the distended ab- 



89 



domen is tense in every part, the swollen veins give 
to the whole a bluish appearance, while the hands 
and arms are wasted, the features drawn in and 
haggard, presenting the appearance of what has 
been termed " facies hippocratica j" the legs 
are also often wasted, and indeed always, early 
in the disease, but at length the pressure of the 
immense body of fluid in the pelvis prevents the 
return of blood in the iliac veins, and the lower 
extremities become anasarcous. The pulse is 
quick and feeble ; the tongue red, and rough with 
prominent papillae, and sometimes aphthous ; the 
urine is very scanty, and deposits a pink sedi- 
ment, like the finest rouge ; the thirst is insup- 
portable ; and the alvine excretions scanty and 
ill-coloured,, the bowels being sometimes difficult 
to move, at others affected with diarrhoea. 

To such a condition of disease it would be 
impossible to propose a cure, unless our art ena- 
bled us to repair the greatest extent of visceral 
disorganization. When the effusion is recent, 
indeed, advantage is occasionally derived from 
rubbing in mercury over the whole abdomen ; a 
drachm of the liniment hydrarg. may be used for 
this purpose, rubbed in morning and evening ; 
three grains of calomel, with double the quantity 
of rhubarb, being given every alternate night, 
and followed by a senna draught, with crystals 
of tartar, in the morning. 



90 

It is to this condition of disease, that on the 
continent, and indeed in our own country, the 
infusion, and decoction, and extract of the dande- 
lion, have been thought peculiarly well adapted 
as a deobstruent. 

It has, especially in Germany, been considered 
of great efficacy • and was prescribed by Zimmer- 
man for the dropsy, which terminated the life of 
the great Frederick of Prussia. Had the philo- 
sopher persuaded the monarch to abstain from 
eating enormous quantities of most indigestible 
food, he might, perhaps, have succeeded in re- 
tarding the disease, and the virtues of the taraxa- 
cum have been still higher extolled. I have seen 
this medicine prescribed in hospitals, in very 
large doses, in extract; I have seen it, both 
abroad and at home, given in decoction and in- 
fusion, without ever being able to trace any ob- 
vious effect from its use beyond slight diuresis, 
or occasionally, when in large quantities, relaxa- 
tion of the bowels. 

The patients labouring under this form of 
disease are scarcely able to bear the elaterium : 
the injury to the principal organ of nutrition, 
and the weakened frame, sustain ill the violent 
effects of this medicine, and the patient's chief 
comfort is derived from the use of diuretic drinks, 
- especially nitre in solution, which relieves the 



91 



craving thirst more than any other remedy. 
The action of other diuretic remedies will be 
found described in the former part of the work : 
it is unnecessary to repeat the observations here. 

Where the disease is very far advanced, I have 
occasionally (in one or two instances) seen tonics 
do more on the intermediate days, when the pur- 
gative formerly mentioned is not given, than 
any of the ordinary hydropic remedies. Two 
grains of the sulphate of quinine dissolved in two 
ounces of water, with a few drops of diluted 
sulphuric acid, and rendered more palatable to 
the stomach by the addition of a drachm of 
the tinct. cardamomi c, have appeared for 
a few weeks to work wonders, and to impart 
at least to the patient that hope without which 
his state would be even less supportable than 
it was. In such cases, also, some relief is ob- 
tained by sustaining the patient's strength ; thus 
enabling him, as it were, to support life under 
extensive disease of structure which no known 
remedies will relieve. The preparations of iron 
are consequently occasionally used with success. 
The muriate of iron acts also in such cases some- 
times as a powerful diuretic. Ten minims of the 
tincture may be given thrice daily in infusion of 
quassias. 

When the collection of fluid has existed during 



92 



some weeks, the mind of the practitioner is di- 
rected to the immediate relief of the distention, 
by tapping. There is some little difference of 
opinion in the profession, as to the best time for 
performing the operation ; some postponing it 
until a fair trial has been given to the operation 
of medicine, others thinking that the cure will 
be expedited by performing the operation as 
soon as the fluid has become very abundant. 
The arguments brought forward for this method 
of proceeding are, — 1st, that by drawing off the 
fluid the organic disease may be ascertained. 
2dly, that it is well known that diuretic medicines 
producing little effect while the distension is ex- 
cessive, become extremely efficient as soon as the 
fluid is evacuated : of this fact there is no doubt. 
It has occurred to me to see patients, the night 
succeeding the operation, void several pints of 
urine under the use of the same remedies which 
had failed in producing as many ounces previous 
to it*. 

Still in such cases I am not inclined to advise 
it until purging, with neutral salts, and mercurial 

* P. Frank, though recognizing the fact, still objects to 
early tapping. 

te Mais les cas rares ne doivent pas servir de base aux indi- 
cations. Si la paracentese augmente frequemment la secretion 
des urines, souvent elle n'exerce sur elle aucune influence 
Sensible." 



93 



frictions, have been tried. It is not unaccom- 
panied with danger from peritoneal inflamma- 
tion ; and, as is well known, the necessity for 
having- recourse to it speedily recurs. 

Where the liver has been contracted during* a 
long period, has a puckered peritoneal coat, or 
that membrane is thickened like semi-transparent 
horn, its sharp edge having entirely disappeared, 
or where the secreting vessels are uniformly 
obstructed, the fluid drawn off is quite limpid, 
and enormous in quantity. 

If clear serum, but deeply tinged with blood, 
follow the introduction of the trochar, we may be 
certain that a malignant growth of considerable 
size, (so large as to press upon the blood-vessels) 
often attached to the liver or ovarium, is the 
cause of the peritoneal dropsy. I am not to be 
understood to say, that when a large morbid 
growth in the abdomen, of the kind termed fun- 
goid or malignant, proves fatal, accompanied by 
dropsy, that the serum is always bloody ; but 
that this bloody serum, when it does occur, al- - 
ways depends on such morbid growth. In many 
cases in the hospital I have seen this remark veri- 
fied, so that I believe it to be strictly correct. 

There are two other principal appearances of 
the fluid drawn off in abdominal dropsy by the 



94 



operation of tapping : it is often of a pale yellow 
colour, more or less tinged with bile, and on 
standing quickly coagulates. 

The last appearance is from cases in which the 
collection of fluid is not large, and principally 
from patients of an early age and strumous 
habit of body. It is the colour and consistence 
of whey, with shreds of lymph floating in it ; 
and is undoubtedly the product of inflammatory 
action, modified by the constitutional disease we 
have mentioned, for where acute inflammation 
of the peritoneum terminates in similar effusion, 
it uniformly proves fatal : it is the product, there- 
fore, of a slower inflammatory action than in 
acute cases. 

Those who advocate inflammation as the cause 
of dropsy in every case, consider that these con- 
ditions of the fluid are produced by different 
degrees only of that morbid process, varying from 
acute through various subacute stages of inflam- 
mation. 

In the last kind of effusion which we were 
considering, inflammation undoubtedly appears 
to have been present. In the other cases, inflam- 
mation may have been and probably has been the 
cause of the thickening, and hardening, and con- 
traction of the liver, but the effusion is a conse- 



95 



quence of this alteration of structure already 
produced : and in cases of serum effused from 
the pressure of malignant tumours, these peculiar 
formations are, I believe, traced by no one to 
true inflammatory action at their commencement 
or during' any part of their growth. 

In speaking of anasarca I remarked that, in 
very severe cases, the sudden subsidence of the 
effusion was an occurrence of very dangerous 
import. The same applies to the sudden disap- 
pearance of ascites after the affection of the liver 
of which we are speaking, but the phenomena 
are different : the disappearance of the fluid is 
preceded by frequent and almost uncontrollable 
vomiting ; or if the water has been drawn off by 
tapping, and does not again collect, violent pains 
in the bowels occur, accompanied by diarrhoea, 
which is at last often not to be restrained by any 
of the usual remedies. Where such cases have 
occurred, I have anxiously looked, after death, 
for some cause to explain these remarkable 
symptoms. Avery unusual appearance has pre- 
sented itself : the intestines are of a deep leaden 
blue colour throughout their whole extent, and 
the omentum of the same colour; the perito- 
neal coat covering the intestines thickened and 
opaque. Sometimes shreds of lymph, of no very 
recent formation, adhere to the convolutions, but 
in general the whole peritoneal covering of the 



96 



intestines is only thickened equally throughout, 
and of this blue colour. I have known the pain 
and diarrhoea immediately succeed the disappear- 
ance of the fluid, and last during" several weeks, its 
severity little mitigated by remedies, and I have 
been in the habit of pointing out its unusually 
fatal import to the pupils. In every case in 
which such symptoms have preceded the termi- 
nation of the patient's life, the ascites has been 
occasioned by the peculiar, hardened, and con- 
tracted state of the liver, which I have attempted 
to describe. 

In speaking of the several forms of ascites 
which arise from a contracted and hardened 
liver, I am not to be understood to overlook that 
effusion of fluid into the abdominal cavity which 
succeeds to enlarged and hardened liver and 
spleen. So long as the liver is soft in its tex- 
ture, and a sufficient quantity of healthy paren- 
' chyma is left for the peculiar circulation in this 
viscus, it may be enlarged so as to occupy the 
whole abdomen, without being the cause of 
ascites : but if the enlargement be accompanied 
by hardness, effusion (less indeed in degree than 
the former case, and more tractable by medical 
art) will take place. 

This is especially the case in ascites which 
arises after enlargement of the liver and spleen, 



97 



from repeated attacks of ague. During' the 
cold stage of an intermittent, the blood recedes 
from the surface of the body into the viscera, 
a hot or inflammatory stage succeeds, and the 
repetition of these paroxysms is followed by 
enlargement of the viscera before mentioned ; ' 
and after repeated attacks, by ascites, or in its 
place, frequent and sometimes fatal epistaxis, - 
or vomiting of blood. In such cases the 
well-known cause, and indeed the enlargement 
of the viscera, which may be felt through the 
integuments of the abdomen, render the case 
clear. 

From the time of Sydenham*, purging at the 
conclusion of ague has been insisted on ; and by 1 
thus drawing off from the enlarged and dis- 
tended vessels, the increased size of the organ is 
prevented. Where such means are not adopted, 
or the unhappy patients are obliged to be exposed 
to the noxious exhalations which occasion repeated 
attacks of thedisease — as in the Maremma and the 
Pontine marshes in Italy — the thin and haggard 
countenances, the swelled, protuberant belly, and 

* " Sublato morbo aeger sedulo purgandus est; incredibile 
enim dictu, quanta morborum vis ex purgationis defectu post 
febres autumnales subnascatur. Miror autem hoc a media's 
minus caveri, minus etiam admoneri." — Sydenhami Opera } 
art. Febr, Interm. 

H 



98 



absence of nutrition, point out this disease in 
characters not to be mistaken. 

Fortunately, except under very aggravated 
circumstances, the effusion and its cause are re- 
moved, and the patient permanently cured, un- 
less constantly exposed to the miasmata. Mer- 
curial frictions have often a most extraordinary 
effect in this disease, reducing the swellings, and 
from their diuretic power carrying off the effused 
fluid at the same time. To these saline purga- 
tives should be added ; and it is remarkable that 
mineral waters possessing purgative qualities are 
often found in the neighbourhood of marshy dis- 
tricts, affording the ready means of relieving the 
diseases engendered by a sojourn in these un- 
healthy regions. The waters of St. Filippo, in 
Tuscany, are annually resorted to for this pur- 
pose : they resemble in some measure the waters 
of Harrowgate, often drunk in our country, to 
relieve the chronic diseases of the liver, con- 
tracted during a residence in India. The waters 
also of Monte Catini, near Pisa, are celebrated 
also in that country, whose marshy districts 
abound with ague, for the cure of visceral ob- 
structions. 

The practice also of letting fall a column of 
hot water on the affected part, under the name 



99 



of douche, affords a very effectual method of ' 
reducing" the swellings of the viscera. This prac- 
tice in France and Italy, in such cases, is almost ■ 
universal. 

Modern discoveries also have afforded a most 
powerful agent in reducing" these swellings, 
when of long standing*, in the hydriodate of 
potass. Two or three grains of this salt, taken, 
dissolved in two or three ounces of water, twice 
daily, will sometimes succeed when other remedies 
fail : under its use the patient's strength and 
appetite will return, while the dropsical effusion 
subsides gradually, with an increased and limpid 
flow of urine. Of course, if the enlarged viscera 
be painful to the touch, it will be advisable to 
apply leeches repeatedly, before having recourse 
either to mercurial friction or the use of the hy- 
driodate of potass. Where mineral waters cannot 
be obtained, the best saline medicines are the tar- 
trate or supertartrate of potass, or the Rochelle 
salt (tart. pot. et sodee), in the dose of from half an 
ounce to six drachms, every morning, dissolved 
in half a pint of water. 

The use of bark in the cure of ague suggested 
to many authors the continuance of its employ- - 
ment in the visceral obstructions consequent on 
frequent attacks of that disease ; but physicians 
who entertained such opinions were almost uni- • 



100 



formly obliged to mix with this medicine some 
evacuant, generally a diuretic. It will appear 
by the following opinion of Frank, that bark is 
ineffectual, even in the hands of the advocates 
for debility, without such an addition : — 

"Thus, even in the dropsy which succeeds to 
intermittent fever, when the patient derives no 
advantage from the bark, or cannot bear it, we 
add gentle diuretics to this medicine, and gra- 
dually increase them by the addition of the 
more powerful ones : we first combine cream 
of tartar and juice of elder-berries, afterwards 
with oxymel scillae in form of electuary. This 
combination produces often the effect which 
cannot be expected from bark alone. In this 
state of sensibility, bark is often less efficacious 
than bitters, such as the lesser centaury, the 
trifolium fibrinum, absinthium, quassia, together 
with the root of the ononis spinosa, whose diu- 
retic properties we have often experienced, or 
with the berries of juniper*." 

* Frank, Medeoine Pratique, Retentions Aqueuses, p. 240. 



101 



CHAPTER VI. 



ASCITES FROM DISEASE OF THE PERITONEUM. 



Tcberculated accretion of the peritoneum has 
been so ably described by Dr. Baron,, of Chel- 
tenham, that I should not here speak of it, ex- 
cept on account of the ascites, with which it is 
often accompanied. The disease, where it proves 
fatal early, consists of a pearly thickening of the 
peritoneum, the membrane being* pushed up by 
numerous eminences, or tubercles deposited on 
the cellular side of the serous membrane : in 
more chronic cases, large masses of thick cheesy- 
looking matter are deposited on the cellular side of 
the omentum, sometimes distending it, like a 
bag, into an unequal globular tumour ; at others, 
into a thick flat mass, compressing the intestines 
like a pad. In this form of disease there is often 
vomiting, and vomiting of a peculiar character; 
it is of a deep leek-green colour ; precisely the 
colour of the beautiful fluor spar, found at Alston 



102 



in Cumberland ; sometimes varying 1 to purple. 
I am not to be supposed to say that this peculiar 
vomiting" occurs in every form of this disease ; 
but where it does occur, in every instance the 
disease so faithfully described by Dr. Baron has 
presented itself on the examination of the body. 

My attention was first called, about thirteen 
years ago, to this circumstance, in a very remark- 
able case, at Guy's Hospital, under the care of 
Dr. Cholmeley. That accomplished pathologist 
stated at the time, that whenever he had seen 
this peculiar vomiting, the post-mortem appear- 
ances were those of the disease alluded to, and 
thus it proved ; and in consequence of this veri- 
fication I have been enabled, in several instances 
where the symptoms were obscure, to determine, 
from the presence of this peculiar vomiting, the 
nature of the disease; and I do not remember a 
single instance in which the event did not con- 
firm the diagnosis. At the same time, I do not 
remember to have seen this symptom present 
when the disease was accompanied with ascites, 
the evacuation preventing., probably, the serous 
effusion. 

The dropsy which accompanies this disease is 
always more scanty than that which is the con- 
sequence of disease of the liver; sometimes only 
a few pints, and seldom more than two gallons, 



103 



are poured out : indeed, the latter quantity is, as 
far as my experience goes, the utmost limit of 
effusion in such cases. 

It is more common in young people than in 
old, and in females than in males. 

The dropsical effusion is often mixed with 
shreds of lymph, and is moreorless whey-coloured, 
from the presence, doubtless, of low inflamma- 
tory action, and it more frequently accompanies 
the universal thickening' of the peritoneal cover- 
ing of the bowels, than where accretion of the 
omentum forms the mass of disease : after death 
the small intestines are glued together, and more 
than once I have seen the whole taken out toge- 
ther after death, in one globular mass, by passing 
a ligature round the root of the mesentery. 

The pulse in such cases is weak and quick ; 
the features pinched and sharp, and the tongue 
red and glazed, as if a hot iron had touched it ; 
sometimes of still deeper red colour, with patches 
of aphthae. There is always a sense of weight and 
distension in the abdomen, even where no ascites 
is present. 

Mercury administered internally is rarely at- 
tended, in my opinion, with advantage ; nor does 
powerful purgative medicine seem to produce 



104 



any really good effect, and it is apt to induce vo- 
miting, which is much to be dreaded. The 
disease occurs in strumous constitutions, and ap- 
pears to arise from inflammation, modified by 
that constitutional disease, as intractable as chro- 
nic strumous ophthalmia, or chronic scrofulous 
disease of the joints, or the slow inflammation 
and suppuration of lymphatic glands, are, by 
antiphlogistic remedies. 

I have observed that where effusion takes 
place, it often arises early in the disease 5 whereas, 
where the disease is fully established, and the pro- 
longations of the serous membranes are formed 
into hard masses, it is more frequently absent, 
while peculiar and fatal vomiting relieves the 
obstructed circulation ; and hence it is, I think, 
that I have seen several young patients rally, 
where the dropsy appeared early from this organic 
affection. 

The disease is not so very common as to enable 
any one to lay down a general rule, or to speak 
positively on the subject : here I only relate the 
result of my own experience. Tapping has uni- 
formly been followed by bad results, increasing 
the low inflammatory action, and tending thus, 
perhaps, to exasperate the disease ; at least, I have 
never seen a case recover after this operation 
has been had recourse to ; and as the collections 



105 



of fluid are rarely very great, the urgent desire 
of the patient to be relieved from the distension is 
not so strong as in effusion into the peritoneal 
cavity from other causes. 

If, when the physician is consulted, the pain 
on pressing the abdomen be severe, one bleeding 
from the arm will be necessary, or if the patient 
be weakly, a dozen leeches may be applied to 
the abdomen : further than this,, antiphlogistic 
practice appears to be hurtful, and in many cases 
the practitioner is not consulted until the results 
of slow inflammation have been established; thus 
rendering depletion improper, as weakening the 
forces of the patient, without controlling the 
action which first produced the disease. 

Frictions with the liniment hydrarg., morning 
and evening, are often attended with benefit, but 
it is on the use of the hydriodate of potass that I 
have been accustomed to rely, from finding the 
general health recover under its influence, and 
the effusion, hardness, and tightness of the ab- 
domen, disappear in a remarkable manner. Two 
grains of this salt, given in a draught of equal 
parts of cinnamon water and common water, 
with a little syrup, may be administered for several 
weeks, twice in the day, with no other visible effect 
than the amendment of the patient's health, or if 
any visible effect is produced, it is slight diuresis ; 



106 



even during" its employment, a few leeches may 
occasionally be applied with advantage where 
there is any pain on pressure : if restlessness and 
sleeplessness be present, five grains of the ext. 
conii may be given with each draught, in the 
form of pill. 

The bowels in this disease are generally con- 
stipated, but the secretions, when obtained, are 
often not unhealthy : it is difficult to move them 
with colocynth or similar medicines, from the 
pain they occasion, or with mercurials, from the 
vomiting- which often accompanies, and the de- 
bility which succeeds to their use. In such cir- 
cumstances the medicine which I have found 
best to agree, is the phosphat. sodas, of which half 
an ounce or six drachms may be given daily in 
a pint of beef tea. It is not disagreeable, and 
can sometimes be borne by stomachs which, 
from organic disease, reject every thing pre- 
sented to them. Whether really these neutral 
salts possess a deobstruent power, (as the sulph. 
of potass was supposed to have in tabes mesen- 
terica), or the good effect is owing to the regular 
and long-continued evacuation of the bowels, I 
cannot assert, but I can safely recommend them 
as a most convenient laxative in the disease I 
am commenting upon. 



A few months since I attended, with Mr. 



107 

Merriman, jun. of Kensington, a young lady, 
set. 13, affected with ascites apparently arising 
from this disease. Under the plan laid down, 
persevered in for several weeks, not only the 
effusion disappeared, but the tumours also be- 
came imperceptible on minute examination. 

Ascites is also sometimes the consequence of 
other diseases. Very solid tumours of the ovary, 
or enlargement of the ovary, with much of the 
structure in the cysts solid, will often, from 
pushing upwards the intestines, compress veins 
of the venae portae, and produce ascites. It is not 
unfrequent to see the introduction of the trochar 
followed first by clear serum from the peritoneal 
sac, and afterwards by ropy muco-albuminous fluid 
from a cyst in the ovarian tumour. In a case in 
which Mr. Caesar Hawkins operated, eleven 
pints were drawn off from the peritoneum, and 
nine from the cyst. In such cases, the recumbent 
posture and diuretic remedies will often relieve 
the ascites in a remarkable degree, and after a 
time the tumour often shifts its place, and the 
local pressure is removed. 

Some persons, even the great Morgagni himself, 
have attributed dropsy, in some cases, to bursting 
of the lymphatics, and ascites to bursting of the 
thoracic duct. I have carefully examined the 
thoracic duct, in many cases of ascites, but never 



108 

could detect any alteration except distension in 
it and the lymphatics. Neither does simple ob- 
struction of glands appear to occasion dropsy, 
by pressure on the lymphatic vessels : large col- 
lections of diseased glands are found in the axilla, 
pelvis, and in the neck, but without dropsy. 
The enlargement of the mesenteric glands is 
more frequently accompanied by marasmus 
than by dropsy : and even when ascites is pre- 
sent in combination with this disease, there is 
also the slow scrofulous inflammation of the pe- 
ritoneum which we have just been describing, 
or the glands are so much enlarged as to press 
on the trunk of the vena portee. 

In the same way, if the glands in the groin or 
axilla enlarge in such a manner as to press on 
the great veins of the extremities, there will be 
oedema below the pressure, but otherwise it is of 
daily occurrence to meet with lymphatic glands 
of great size and hardness, without any dropsical 
effusion : for the tension, redness, and heat, 
with slight effusion, occasioned in the neigh- 
bouring cellular membrane, by inflammation of 
these tumours, cannot be referred to dropsy, 
though some writers have imagined that they 
saw the first pathological process towards the 
formation of dropsy, in this pouring out of fluid 
by the capillaries in the vicinity of an inflamed 
part. 



109 



Ascites does not succeed eruptive diseases as 
frequently as anasarca ; and it has never oc- 
curred to me to see it alone after one of these 
diseases. One case I have heard of was entirely 
cured, even after tapping" had been proposed, by 
the use of the infus. pyrolae umbellatse ; and con- 
tinental authors speak highly of spartium sco- 
parium, and an infusion of the root of the 
ononis spinosa. When it occurs early, it is pro- 
bable that its progress would be best stopped by 
antiphlogistic remedies and saline purgatives. 



APPENDIX. 



APPENDIX. 



It was originally my intention to have presented 
to the profession in this Appendix the transla- 
lation of the whole work of M. Geromini, from 
the original Italian. I have since retrenched 
the chapters in refutation of the doctrines of 
the late Dr. John Brown ; because the opinions 
which gave rise to Geromini's arguments have 
long since faded into air. Brunonianism, soon 
after its appearance, exercised most extensive 
influence on the practice of physic in Southern 
Europe, and it is remarkable that this specula- 
tive theory, which neither attained great or ex- 
tended reputation in the country which gave it 
birth, should have been looked upon with the 
greatest respect in Italy. 

Rasori, Tommasini, and the followers of the 
contra-stimulant doctrines, have long since given 
it its death-blow : hence no reason exists for pre- 
senting a laboured refutation of its errors. 

1 



114 

It must not be supposed that in presenting 
the labours and reasoning of M. Geromini to the 
profession, in an English translation, I coincide 
with him in his opinion of inflammation being 
uniformly the cause of dropsy : just in the prin- 
cipal arguments, I think he fails in establishing 
his conclusion. Inflammation, indeed, may have 
caused the visceral diseases, but it is the altera- 
tion of structure consequent on such diseases, 
which, in a large proportion of cases, produces 
the dropsical effusion. 

E. J. S. 



115 



ON 

THE CAUSES AND CURE 

OK 

DROPSY, 

From the Original Italian of Dr. F. C. GEROMTNT. 



CHAPTER I. 

Of the Theories of Physicians to the time of Brown, 
respecting the Causes which produce Dropsies ; 
and also those of the great Anatomists who have 
illustrated (the Structure and Functions of) the 
Lymphatic System. 



The theories respecting the causes of dropsy, esta- 
blished in the different medical schools, according to 
the respective pathological principles which chiefly 
governed them, reduce themselves, in point of fact, to 
very few varieties, including those of the time imme- 
diately preceding our own, in which these theories of 
the ancients, with more or less dexterity, have been 
reproduced. 

Looking back to the time of Erasistratus, we learn 
from Galen and from Celsus, that this physician 
referred the cause of dropsy to a diseased change in 



116 



the liver, and hence rejected the operation of tapping, 
as unnecessary. Hippocrates held, that dropsy was 
generated when the liver was impregnated with pitui- 
tous humour : and notwithstanding that, in the first 
book de Morbis Mulierum, he described a dropsy 
from affection of the spleen, he states clearly, that 
(C hydrops ab hepate oritur quum ad hepar pituita ac- 
cesserit, eamque hepar exceperit et humectum red- 
ditum fuerit." 

From thence Galen, and the immense crowd of his 
followers, established, that the cold temperament of 
the liver, generating, instead of good blood, both pitui- 
tous humour and water, was the cause of every dropsy. 

Areteeus, the Cappadocian, who left so accurate a 
description of the dropsy, appears to make it consist 
in a higher degree of cachexia, in which the degene- 
rated fluids change into water. 

But the cold temperament did not please Alexander, 
Trallianus, Avicenna, Cardanus, &c, because they 
were obliged very often to treat the disease with re- 
frigerating remedies : hence they decided that dropsy 
proceeded from the opposite temperament. 

Trincavellus, all-faithful as he was to the doctrines 
of Galen, confesses that sometimes the dropsy suc- 
ceeds, " ex jecinoris inflammatione, et ex inflamma- 
tionibus aliorum viscerum, praesertim mesenterii gra- 
cilium intestinorum.' , 

At length other practitioners perceived that this was 
not always associated with diseases of the liver, but 



117 



other alterations of almost any viscus accompanied it. 
Piso, Sennertus, Riverius, decided that the cold tem- 
perament of the liver might well be the cause of 
anasarca, in which a general poverty of healthy blood 
was discerned, but not of ascites ; and leaning on the 
authorities of Hippocrates and Aristotle, in reference 
to the use of the abdominal viscera, attributed it most 
frequently to a defect in the power of collecting the 
superfluous humidity, which arose, moreover, <c aut 
extinguendo, aut suflfocando, aut dissipando calidum 
innatum," not alone from the liver, but also from the 
spleen and kidneys : the first, Piso, having excel- 
lently observed, that " tumorem aliquem alterntrius 
visceris fere unam esse certe frequentissimam ascitis 
parentem." Here, however, serious questions arose 
how to determine by what means those fluids found 
their way into the abdominal cavity ; some asserting 
that they dropped by cc meatus insensibiles" (inorganic 
pores of our physiologists), and others by the extre- 
mities of the vessels of the mesentery, and more especi- 
ally of the diseased or corrupted omentum, depending 
for proof on the anatomical and pathological observa- 
tions of Columbus, Heintz, Rondelezius, and others. 

Finally, setting aside the chemical and spiritual 
ideas of Paracelsus and Vanhelmont, and arriving at 
the opinions of physicians after that " Hepar dejec- 
tum fuit ab imperio sanguificationis ipsiusque publicae 
ductae exequifle," we will speak of Willis, who, after the 
knowledge of the existence of lacteal and lymphatic 
vessels, established in reference to the causes of dropsy 
a very admirable complexity of opinions, which have 
been repeated even to our own days. Of the cause of 
ascites, in fact, he promulgated the opinion that it was 



118 



produced either by the effusion of the serum of the 
blood, or of the chyle, but especially of the former; 
and of this effusion of serum of the blood he af- 
firmed, that it migh t arise either from alteration of 
the composition of the blood itself, or of the vessels, 
or of both of these ; of which when " partes consti- 
tutivas intra compagem suam baud rite continet, quia 
ad dissolvendum aptus, serositates suas a mixtione 
passim rejecit, quas vel foras per urinas, aut sudore 
ablegat, vel intus residere permittens, in carnium 
poros aut in viscerum cavitates detrudit ; ovvero juxta 
arteriarum et venarum intercapedines aut inoscula- 
tiones effluere sinitur." 

Of the sanguiferous vessels, when their extreme 
mouths or openings (( aut nimis laxa, aut processus 
occlusa existunt," principally when there are schir- 
rous tumours, tubercles, and other preternatural 
concretions in the mesentery, spleen, liver, uterus, or 
any other viscus, which delay or impede the free 
course of the blood : reflecting, moreover, that the 
effused fluid not " mere serosus est, sed insuper 
liquor nutritivus solidisque partibus alendis desti- 
natus; quare dum hsec regio intumescit, membra ex- 
tenuantur et lympha ascitse exempta instar ovi albu- 
minis a calore inspissatur et albescit." 

Finally, to prove that ascites may be produced by 
rupture, or other diseases of the lacteals and lympha- 
tics, he reports the case of a patient labouring under 
ascites and jaundice from whose abdomen was ex- 
tracted, by tapping, a great quantity of water, not 
tinged yellow, but limpid, and thence he infers w humo- 
rem istum hydropicum, non e massa sanguinem pro- 



119 

fluxisse ; turn enim coloratus fuerit, sed e vasis lymphoi- 
ds aut lacteis in abdominis cavitatem extillasse." 

From which case, moreover, while we, for other 
reasons, as well as for this, (viz., the thin and limpid 
nature of the liquid,) cannot so easily accord with his 
opinion that the dropsy arose from the rupture of the 
lacteals, we may incidentally remark, that this ex- 
ample serves wonderfully well to prove the opinions 
which we are about to explain. For by admitting, 
as will be seen, a new morbid process of secretion 
from the inflamed surfaces of membranes as the ge- 
neral cause of dropsy, it is easy to explain how the 
fluid of the ascites in the case of jaundice, did not par- 
take, in the slightest degree, of the colouring matter 
of the bile. But it is in reasoning on the anasarca, 
that Willis, repeating with his predecessors that it 
arises from defect or degeneration in the blood, loses 
himself in his chemical ideas of sulphur, spirit, and 
salt, wishing to shew that it is a defect in fermenta- 
tion and combustion (accensione), that the hydropic 
diathesis consists. Etmuller leaned on Willis's opi- 
nion in his explanation of dropsy ; for besides ad- 
mitting the rupture of the lacteal and lymphatic 
vessels, either from external lesion, or from the acri- 
mony of the lymph distending and corroding them, or 
from the ulceration and induration of the mesenteric 
glands, he recognized that dropsy proceeded " ex- 
insigni et notabile vitio in haematosi contingente 
through which the blood " attenuatus et resolutus, 
tandem certis in locis decumbit et extra vasa cum 
vehiculo seroso subsistens tumorem talem infer t.'* 
Nor does he omit, however, the other cause, viz., 



120 



the impeded or retarded course of the blood in the 
sanguiferous vessels, supported by the famous expe- 
riment of Lower. Nor are the opinions of Lister 
very different, who states in these words the origins 
of dropsy : — 

" Chylus a vitiato ventriculo ejusque digestione 
cruda et imperfecta lentescit unde a venis lacteis 
parum et nihil purgatus, cordis sanguinisque adeo 
mo turn impedit, inque venis primum lymphae ducti- 
bus, ubi motus cruoris circumacti languere incipit, 
segnescit, accumulator, corrumpitur." 

But Morton considered decidedly, that dropsy could 
arise from rupture of the chyliferous and lymphatic 
vessels, caused by the swelling of the glands of the 
abdomen, of the thorax, of the limbs, " per quas ilia 
vasa perrepunt et sufFulciuntur j" and that from this 
effusion of chyle or of lymph, the blood " solita in- 
stauratione privatus valde depauperatur accessit et 
incallescit." Hence the fever, the thirst, the wasting 
of parts. The history, however, which he reports, 
in order to prove his opinions, demonstrates a very 
different state of things. It respects a child who fell 
ill of pneumonia, in whose case bleeding was 
omitted, until the author was sent for very late in the 
disease, as he assures us that the condition of the 
patient did not improve after bleeding and blistering, 
but towards the conclusion hectic fever and ascites 
arose, which increasing daily, the patient died, greatly 
wasted. 

The lungs (says the author) were healthy, except at 



121 



the posterior part, where were found " tubercula seu 
glandulas pulmonales valde tumefactas," which, by 
compressing (as he thinks) the thoracic duct, and im- 
peding the progress of the chyle, occasioned the rup- 
ture of the lacteals, and hence the continued chylous 
effusion which constituted the dropsy. Every one 
sees in this case, that this rupture of the lacteals, how- 
ever much the illustrious author treats it as certain, 
is purely hypothetical : nor do we believe that any 
one, whatever may be his faith in, and veneration for, 
Morton, will believe it, as Vanswieten did, solely on 
his word, without even knowing if he had employed 
the usual anatomical contrivances to prove the truth 
of it; the more so, as it is known from Monro and 
others, how very difficult, if not impossible, rupture 
of the lymphatics would be. We believe also, that 
no one would maintain, on such slight foundation, 
that these tubercles on the posterior surface of the 
lungs could in fact compress the great duct of the 
chyle, so as to obstruct it in its whole course. On the 
contrary, who does not clearly see, in this pulmonary 
disease, a manifest indication of preceding inflam- 
mation, and from this the cause of the dropsy ? 

Sydenham hastens over the subject admirably, and 
urges that " causa hujusce morbi in genere, sanguinis 
debilitas est, unde alimento quod forinsecus impor- 
tatur in substantiam suam convertendo non jam par, 
idem in extremitates et pendulas corporis partes ex- 
plodere necesse habet et in abdomen etiam." 

Again, in considering the opinion of the great Hoff- 
man, (that physician of exalted talent, formed in the 



122 



accurate school of Leibnitz, whose works we deeply 
deplore should be neglected by the greater part of 
young physicians, since in the midst of no few errors 
incident to his time, they would find great lights of 
truth, and many of the seeds of the opinions of Cullen, 
and of the recent theory of excitability,) we may ob- 
serve, that the same experiment of Lower, which 
suggested to Willis, Etmuller, and Lister, the idea of 
the retardation and stagnation of the blood in the 
sanguiferous vessels, as one of the causes of dropsy 
enumerated by them, moreover led the more saga- 
cious and ingenious Hoffman to establish, in that 
alone, the explanation of the production of the dis- 
ease ; and although he has embellished this theory, 
and rendered it not a little attractive in reference to 
the anasarca, that the blood suffers retardation in re- 
turning by the veins to the heart, and because it flows 
against the force of gravity, and because " venarum 
tunicae non tanta vi systaltica et motrice elastica 
praeditas sunt quam arteriae;" to which he adds both 
their natural and morbidly increased tenuity and po- 
rosity, in consequence of which the light serum might 
easily transude ; which opinion he moreover extends 
to explain the formation of ascites, amplifying beyond 
reason the disadvantageous condition of the circu- 
lation in the liver ; in regard to which, resting on the 
observations of dissections, he retains the opinion of 
the ancients 9 " praecipuam ascitidis sedem 5" this 
theory, we maintain, although not without the appear- 
ance of truth, did not accord sufficiently w T ith just 
reasoning and an accurate analysis of facts : and in 
truth we must confess we cannot so easily imagine how, 
during the retardation of the circulation in the veins, 



123 



the more subtle portion of the blood must transude 
through their coats. It is true there may be pores 
common to the whole body, and also those which have 
been added by physiologists, and termed inorganic : 
it must, however, be clear, even if this transudation 
could happen, it demands on the one part an enor- 
mous force to compress internally the column of 
fluid, and on the other an absolute impediment to the 
smallest progress of the circulation. Now the first 
(the compressing force) cannot be imagined in the 
slightest degree, if the slowness or stagnation of the 
blood in the vessels (the second of Hoffman's causes 
of the supposed serous transudation as a cause of 
dropsy) arise from a weakness of the vessels them- 
selves, or general debility of the whole frame. In 
reference to the second, a cause being assumed in any 
part, which, either by compression, or by any other 
mode, impedes altogether the circulation of the blood 
in any vessel, (which in truth it would be extremely 
difficult to verify), who does not perceive that it 
would be far more likely to happen that the valves 
should give way, and the blood take on a retrograde 
movement, than that its component parts should di- 
vide, and the more liquid parts transude through the 
coats of the vessels, however tender they might be ? 

But here the experiments of Lower are opposed to 
us ; and on this head we are obliged, for other 
reasons, to stop a little, seeing that on these ex- 
periments Millman rests his opinions, in his cele- 
brated work on dropsy. And first of all, to take 
away from these experiments a little of the appear- 
ance of their irrcfragability, in the eyes of almost 



124 



all pathologists, it will not be useless to reflect, in- 
asmuch as relates to the aqueous collection observed 
in the abdomen of the dog, in which Lower tied the 
vena cava, that the lesion of surrounding parts, which 
this operation must necessarily have occasioned, might 
have produced an inflammatory action, to which the 
effusion mentioned would succeed : and in reference 
to the tying of the jugular vein, (second experiment 
of Lower), that this does not form the same case 
as that in which there was an obstacle to the circu- 
lation of the blood in the other veins of the body ; 
since, in the one case, it would be altogether diffi- 
cult for the blood to recede, because it would 
have to overcome its own gravity; but not so in the 
other. 

To which observations if it be added, that per- 
haps in practice the case can never occur of an 
obstacle to the circulation of the blood, perfectly re- 
sembling that arising from the experiment of Lower 
by ligature, every one sees how much is detracted 
from the importance which the greatest pathologists 
have attached to these experiments in the arguments 
on the causes of dropsy. 

And if, moreover, it should be wished that we should 
explain the formation of dropsy, according to the expe- 
riment of Lower, we must recollect that, having shewn 
the desired serous transudation through the coats of 
the vessels to be impossible, merely from an obstacle 
to the circulation of the blood, we may reasonably 
assert, either that the dropsy which succeeded to these 
experiments, is not explicable, or that the most pro- 



125 



bable explanation that can be given after the preceding 
reflections, is, that the ligature disturbing necessarily 
the natural deposition of molecules in the coats of the 
vessels, had excited in them an inflammatory process 
capable of generating the serous effusion which 
occurred ; the more, that from the observations of 
Hunter, Abernethy, Sasse, Frank, the possibility of 
the inflammation of the sanguiferous vessels is placed 
beyond contention. 

It is clear, then, that even allowing that an obstacle 
to the regular progress of the blood in the vessels 
accompanies, or, if you will, even remotely occasions, 
dropsy in any part, this does not prevent inflammation 
(flogosi) being proximately the pathological process 
which generates this disease, as we shall go on 
making more clear in the progress of this work j the 
more, that we shall shew in their place that those 
organic alterations are produced by inflammation, 
which, through the knowledge which we have of the 
laws which regulate fluids out of the living machine, 
here appear to exercise their morbid influence as mere 
obstacles to the free circulation of the blood. 

At present we must treat a little of another illus- 
trious writer, Sauvages, one of the most ingenious 
partizans of the Stahlian doctrine. But inasmuch 
as he recognises dropsy to be simply a genus of ca- 
chexia, which we have already seen to have been 
the opinion of Aretseus, we shall occupy ourselves 
with his theory on another occasion, when we treat 
expressly on this last morbid condition ; demonstrat- 



126 



ing how very erroneously physicians have marie a 
particular disease of it, while the signs of it which 
they describe are merely symptoms of various forms 
produced by inflammation. Proceeding instead to 
Boerhaave, and his illustrious disciple, Vanswieten, 
in whose much esteemed commentaries, although we 
cannot expect in fact to discover new ideas on the 
theory of the disease on which we are occupied, (as 
Sprengel wisely observes, they are a mere collection 
of humoral, chemical, and dynamic principles), or any 
thing beyond the already expressed ideas of retar- 
dation of the circulation, superabundant serosity in 
the blood, thickening and viscidity in the lymphatic 
system, vascular and visceral obstruction; we shall 
begin to find joined to these, the increase in the na- 
tural transudation of the membranous surfaces, or 
their defective absorption, supported by the much- 
praised work of the celebrated Kaaw, nephew of the 
great Boerhaave, and in some measure acknowledged 
even by Mead. Nor did the great Morgagni think 
differently, since he maintained with the other physi- 
cians, in reference to the causes of dropsy, " Quae- 
cunque causa diutius potest sanguinis aut lymphae 
cursuin morari, aut humoris quo cavese corporis ma- 
dent prseter modum aut secretionem augere, aut 
exitum deinde imminuere morbo huic potest ori- 
ginem prasbere." Afterwards, a celebrated physician 
of Leipsic, Ludwig, was the true precursor of the 
Scotch reformer, Brown ; for, in the midst of the old 
principles of the humoral pathology, acknowledging 
the principal cause of these diseases, and particu- 
larly of dropsy, to be general debility or atony of 



127 



vessels, and of all the animal machine, he established 
the first curative induction of this disease to be in the 
use of stimulants and corroborants. 

" Vera itaque," he says, (in his Adversaria Medico 
Practica) medendi ratio ad sola roborantia ducit. 
Circulus nimirum universalis in systemate arterioso 
primum sustinetur ut crasis sanguinis bona hujus 
vigore efficiatur, et quern admodum etiam venarum 
vis in suggendo roborantibus medicamentis incitatur 
sic bona etiam mixtio sanguinis a venis suscipiendi 
expeditam reddit resorptionem." 

Also Milman, in his explanation of the formation 
of dropsy, adheres especially to general debility, al- 
though he reduces to three kinds the causes which 
induce the malady. 

"Scilicet ad fibrarum laxitatem, ad vires magnis 
evacuantibus, morbisve acutis, in longum protractis, 
demissas, vel ad impeditum revolubilem sanguinis 
circuitum," 

The theory of debility or atony, as the proximate 
cause of dropsy, we find afterwards followed up by 
the celebrated Vogel. But this physician prefers re- 
straining it to the lymphatic system. " Multos enim, 
(thus he expresses himself) cachecticos ab hydrope 
prorsus immunes esse video vicessimque hydrope sac- 
cato laborantes satis alacres omnisque cachexia? certe 
per longum tempus expertes." 



Further on he adds, that a Si languor saltern 



128 



illis vasis incumbered quae ad demittendos humores 
serosos destinata sunt, certe non difficile est intel- 
lectu quomodo hoc in casu oriri hydrops possit." 

But a real, and not the less elegant, amalgamation of 
all the opinions of writers hitherto enumerated, is Cul- 
len's theory, in his Elements of the Practiceof Medicine. 
In fact, after having published, as other pathologists 
of that time did, that dropsy succeeded either from in- 
creased exhalation or defective absorption, he laid it 
down that this took place either by the bursting of 
the vessels conducting the serous fluids, or the little 
sacs which contained them ; that is, not only by rup- 
ture of the lacteals or thoracic duct, but also of the 
ureters, bladder, &c. : the natural exhalation also, 
according to him, becomes increased. 

1. From causes impeding the return of venous 
blood to the heart, and thus preventing the free pas- 
sage of blood from the arteries into the veins, in con- 
sequence of which the fluids contained in the arteries 
find more easily an exit by the exhalent vessels : and 
as causes for this he enumerates the polypous con- 
cretions in the right ventricle of the heart, the ossifi- 
cation of the valves, the pulmonary hepatization, 
obstruction of the liver, polypi, swellings formed in 
the veins, compression of the veins by aneurismal tu- 
mors, abscesses, schirrous or steatomatous tumors in 
neighbouring parts, or pressure made by the gravid 
uterus. 

2. From want of tone in the exhalent vessels, the 
consequence of the general atony of the system, 



129 



occasioned especially by the abuse of spirituous 
liquors, to which he gives the name of hydropic 
diathesis. 

And here we must remark, that facts themselves 
oblige the author to add plethora as sometimes pro- 
ducing dropsy, principally when it succeeds to the sup- 
pression of some natural or sanguineous discharge ; 
but in truth he thus embarrassed a little his preceding 
theoretical opinions ; to make up for which, he adds 
the superabundance of serum in the sanguiferous sys- 
tem, derived either from the extraordinary quantity of 
water introduced into the body by drinking, or ab- 
sorbed from the atmosphere, or from the diminution 
or cessation of the natural serous excretions, or from 
copious haemorrhages, as well spontaneous as artificial, 
not less than from a defect in assimilation and san- 
guification. 

The natural inhalation afterwards, must, according 
to this author, be diminished or even destroyed* 
from the enfeebled action of the extremities of the 
lymphatics necessary to absorption. And this weak- 
ness in the inhalent action of the lymphatics may 
be, as he thinks, either altogether peculiar to this 
system of vessels, (and thus he thinks that some 
of the active remedies in the cure of dropsy effect it 
by exciting specifically the absorbents), or dependent 
on general atony. 

And here it appears he rejects the obstruction of 
the lymphatic vessels and glands, commonly reputed 

K 



130 



as one of the causes of dropsy, assuring us that he has 
seen similar cases, in which the larger part of the 
mesenteric glands were much obstructed, although the 
passage of the fluids was not visibly obstructed from 
the lymphatic to the sanguiferous vessels, and dropsy 
was not the result. 

In reference to the hydatids observed by the an- 
cients, and especially by Schenkius, as constituting 
various forms of dropsy, he is of the opinion of those 
who consider them to be animals. This union of the 
hypothetical principles of the solid, humoral, dynamic, 
and chemical philosophy, constituted the theory of 
this disease, as well as of every other, in the works 
of Stoll, Dehaen, Storch, Quarin, Borsieri, and in all 
the treatises and compendia of practical medicine 
of the second half of the eighteenth century : then ap- 
peared the system of Brown. But as we must occupy 
ourselves with this separately, we will proceed to the 
opinions on the formation of dropsy conceived by 
some of those meritorious anatomists who have illus- 
trated the structure and functions of the lymphatic 
system. Cruikshank distinguishes three species of 
dropsies : the first arises from the debility of the whole 
body, and consequent relaxation of the extremities of 
the arteries, and atony of the absorbent vessels : the 
second, from inflammation which has preceded, and 
which has increased, the serous effusion : the third, 
from the retardation by some obstacle of the free course 
of the blood in the venous system ; and it is from this 
last cause that he maintains with Plater and witlf the 
ancients, that the extremities of pregnant women, as 
well as those of persons who travel sitting in a carriage, 



131 



or on horseback, swell ; and that oedema succeeds the 
use of splints or bandages in fractures, when applied 
so as to compress the veins. 

But the eminent anatomist of Germany, Soemme- 
ring, maintaining that every dropsy depends always 
on some disease of the absorbent system, prefers at- 
tributing- the before mentioned morbid conditions to 
compression of the lymphatics, rather than that of 
the veins, supporting himself on the experiments of 
Basilewtz, De Cagnion, and on his own. But among 
these, in truth, what proves far otherwise than was 
intended, is the inflammation of a furuncle on the 
dorsum of the penis, which, by irritation of the 
absorbent vessels, occasioned an oedema of the pre- 
puce, which disappeared by degrees, when the furun- 
cle had entirely vanished. Here, then, it would ap- 
pear that he believed something more than mere 
compression to have produced the oedema. But what 
positive idea can we ever make to correspond with the 
expression irritation, up to the present time so vaguely 
employed by medical writers; and if the least equivocal 
meaning which can be attached to it, is, as we see, 
that in this state the mobility of the fibres is increased, 
the inhalent action of the absorbent vessels, far from 
diminishing, ought also to increase ; any thing, rather 
than oedema, ought to be the consequence : instead of 
this, nothing is more obvious to the mind than that 
the oedema was effected and kept up by inflamma- 
tion, in the same way as every other species of dropsy 
is, as we are about to demonstrate. Nor ought the 
inflammation, in the particular case, to have been 
trifling, as the author clearly adds, the part was 



132 



dreadfully painful, and that stranguary, fever, de- 
lirium, and convulsions, were present. 

But what shall we say afterwards, of the explana- 
nation given by the same illustrious author, which 
he thinks he makes with some appearance of proba- 
bility, of the reason why those addicted to spirituous 
liquors become attacked at last with incurable dropsy, 
stating that it arises in consequence of the spirituous 
liquors by degrees condensing the lymph, until ob- 
struction of the glands is produced. In truth, such a 
chemico-humoral idea could scarcely be pardoned in 
Willis ; and on this subject it does not appear to us 
clear, how the physicians who have all spoken of the 
abuse of spirituous liquors as the cause of dropsies, 
have passed over the examination of intermediate ac- 
tions, w r hich constantly occur between this occasional 
cause and its effects, viz., slow abdominal inflamma- 
tion \ and thus they have let escape, by erroneous 
observation, by a less than rigorous analysis of facts, the 
means the most obvious for revealing the true cause 
of the formation of dropsy. In fact, also Cullen and 
Brown, far from recognizing, by means of these facts, 
how erroneous were their preconceived ideas of de- 
bility being the proximate cause of dropsy, by ex- 
plaining its formation from the abuse of spirituous 
liquors, which are essentially stimulant, established 
a principle the absurdity of which we have demon- 
strated—the one calling it atony, and in the language 
of Brown, indirect asthenia : but in reference to this 
last we are to speak in another place. 

The great Mascagni, to whom belongs, as is well re- 



marked, by the clear and luminous Tommasini, " the 
discovery of the lymphatics, born in Italy by the 
labours of Asellius, fostered afterwards beneath fo- 
reign skies, and since returned to the land which 
gave it birth, there to receive perfection/' divides 
dropsies into two classes : the first is the effect of the 
obstruction of the glands ; the second, of the dilata- 
tion of the lymphatic vessels, in consequence of which 
the valves no longer impede the return of the ab- 
sorbed lymph. But, in truth, these causes are not 
supported by any proof; for, in reference to the first 
cause, besides the fact that we do not often meet with 
the glands of dropsical patients obstructed, as Cullen, 
Monro, and Soemmering, assure us, it is certain that 
when they are found changed or degenerated the dis- 
ease is accompanied in the same dropsy with visceral 
obstructions, which attest unanswerably the presence 
of a preceding inflammatory process ; and we are 
obliged to recognize in that very process both the 
origin of the dropsy and of the glandular disease just 
noticed. 

To the second cause may be opposed the abortive 
efforts to inject the lymphatics from the trunks to 
the branches ; although it is maintained by ana- 
tomists that dropsical subjects presenting the lym- 
phatics much enlarged, and much more visible, are 
better adapted for the investigation of this system of 
vessels. 



Finally, Walter, who, together with other illus- 
trious anatomists, denied to the lymphatics the office 



134 



of absorbing the fluids from the different cavities of 
the body respectively — attributing this function rather 
to the veins, whose extremities he believed to be free, 
and absorbing over all the surfaces — imagined that the 
cause of dropsy existed solely in increased arterial 
exhalation. 



135 



CHAPTER II. 

Of the sensible and well-known Morbid Processes, which 
produce an effect similar to Dropsy. 



From among the morbid processes which we see 
under our immediate observation produce a patholo- 
gical condition similar to dropsy, we will choose the 
serous collection that manifests itself under the epi- 
dermis, like a bladder, whenever a plaster of can- 
tharides, or euphorbium, or ranunculus, or any other 
epispastic, has been applied during a sufficient length 
of time \ or that a part has been repeatedly struck, 
or scalded with some boiling fluid. We know not 
where to find facts which more clearly, or under 
our own eyes, disclose the real nature of dropsy. 
But it is moreover true, that the most obvious sources 
of knowledge are precisely those most neglected by 
mankind, as unworthy of their sublime and tran- 
scendant investigations. In fact, in these very cases, 
in which the blind may convince themselves of the 
inflammation which always precedes and produces 
this cutaneous dropsy, no one has ever run away with 
the idea that the dropsy succeeds to the impeded trans- 
udation of the perspiration : no one has hitherto gone 



136 



the length of saying, that the effect of blisters of can- 
tharides applied to the skin (irritants similar to burns) 
arises from their action moderately contrastimulating. 
And does it not appear impossible that, in this case, 
it should not be thought absurd, that inflammation 
should be the effect of a contra-stimulus ? and that 
this serous collection of which we are treating, is 
really the result of inflammation, we can demonstrate 
even by the examination alone of the first and suc- 
cessive effects which succeed to the application of 
condensed caloric, or of any other of the before men- 
tioned irritating causes. If, in fact, the caloric ap- 
plied to the skin is slight, nothing succeeds except 
increased action in the circulation ; the part becomes 
red, is painful, and sometimes it swells ; in a word, 
the first symptoms of inflammation manifest them- 
selves, or some of its most sensible conditions, which, 
moreover, disappear either simply by removing the 
external cause, or by using one or other of the means 
which weaken the organic forces, and particularly by 
those which subtract caloric from the animal system. 
If, however, the heat applied is great and long con- 
tinued, there is inevitably produced a degree of in- 
flammation which causes the effusion of fluid con- 
tained in the vesicles of burns ; if it be very great, it 
destroys immediately, produces mortification by a 
peculiar and perhaps chemical action, and in another 
degree causes suppuration, and hence the reproduc- 
tion of the destroyed substance : from which circum- 
stances it is easy to collect, that the serous effusion is 
undoubtedly produced by inflammation, and that it is 
only necessary to have a given degree of inflammation 
to cause one or other of its products. 



137 



At present, having established this truth, any one 
has a good right to the deduction, if "iisriem effectibus 
eaedem assignandse sunt causae," that also dropsy must 
owe to inflammation the primitive pathological cause 
which generates it ; but if any one should think the 
induction not sufficiently rigorous, inasmuch as the 
resemblance is not sufficiently proved between the 
fluid of dropsy and that produced under the skin by 
the application of blisters, or of caloric in a greater 
or less degree of condensation, he may, in fact, dissi- 
pate his doubts, by the knowledge that the resem- 
blance between the two fluids is not limited only to 
their sensible characters, but is supported by the 
similar conditions of their component principles, since 
both one and the other contain gelatine and albumen : 
when made to evaporate, they leave an album ino- 
gelatinous substance, more or less white, and which 
coagulates when treated with acids. 

But besides the artificial morbid process, a natural 
one may be mentioned, which also generates a pro- 
duct evidently similar to that which constitutes a 
dropsy. In the herpes zoster, a malady which con- 
sists simply of cutaneous inflammation, is there not a 
serous effusion produced — a dropsy similar to that 
caused by burns, or the application of blisters ? 



138 



CHAPTER III. 



Of the Diseases which frequently precede and generate 
Dropsy. 



All the various forms of erysipelatous inflammation 
with which we were occupied in the first part of this 
work, may give rise to dropsy ; and here we speak as 
well of those which attack the skin, as of those 
which affect the internal membranes, which constitute 
certain parts, and involve and confine others. 

Relatively to the cutaneous diseases, we have 
already seen how many impetigines, indicated under 
so many names by nosologists, are no other than so 
many various forms of inflammation, for the most 
part erysipelatous ; proved by the pathological laws 
which they follow, and which are distinctly marked, 
and shewn in a positive manner, and not at all 
hypothetically, by their manifesting themselves alter- 
nately over the external surface and in the interior of 
the human body : hence, where is the marvel that, 
when improperly treated, they should give rise to 
dropsy of the integuments, of the tunica vaginalis, of 
the abdomen, the thorax, or the encephalon ? 



139 



But proceeding to the exanthematous diseases, the 
most common among the cutaneous inflammations 
from which dropsy is generated, as is attested by the 
celebrated Pietro Frank, we will speak of scarlatina, 
of which it is so common a result. Now, as we have 
demonstrated unanswerably, when treating of the 
different forms of erysipelatous inflammation, this 
disease is a decided inflammation of the surface, 
and even approaching a real diffused erysipelas, and 
hence succeeds to similar causes, follows the same 
laws, produces the same results, and is cured by the 
same remedies : when enumerating the morbid pro- 
ducts also, we have recognised the serous effusion 
which constitutes dropsy to be the principal one. 
And in truth, in order to demontrate this fact, too 
often repeated, it is not necessary here to have recourse 
to authorities, as cases occur daily to every practical 
physician, as is asserted by the before-mentioned 
master of his art, that " Copiosos nos non cellulari 
modo hydrope, sed et ascite ac hydrothorace affectos, 
post scarlatina tractavimus." 

And in reference to these two last species of dropsy 
which follow scarlatina, we must believe that the 
production of them is clearly to be understood, since 
we have demonstrated, by daily experience, and with 
the support of the best-established observations of the 
best authors in practical medicine aud pathological 
anatomy, that it is peculiar to this form of inflamma- 
tion, and those similar to it, to attack not only the 
integuments, but at other times the internal mem- 
branes which compose or involve some of the viscera, 



140 



as is demonstrated by the alterations observed in post- 
mortem examinations. 

Neither do we fear any opposition from the fol- 
lowers of Brown, or the first reformers of his doctrine, 
arising from the supposed asthenic diathesis, which 
scarlatina itself will sometimes assume in common 
with the other exanthemata : since we have demon- 
strated evidently, 1st. That this disease is phlogosis; 
2dly. That phlogosis, meaning always increased or- 
ganic action, is opposed to asthenia, (and even, if we 
must apply one of the Brownian visions, diathesis) it 
might be said in a certain sense that it is the intense 
condition of the sthenic diathesis, hence always the 
same, as is the opinion of Professor Tommasini ; and 
this we may assert with more confidence, since we 
have availed ourselves of the same materials on which 
the Brownian pathologists rest their force, and the 
very authorities on which they depend. 

Moreover, in reference to the scarlatina maligna, or 
angina gangrenosa, from an accurate analysis of the 
observations of Huxham and Fothergill, and which 
we have applied also to those of Ballonius, when 
treating of pneumonia, called malignant, we have 
placed beyond any doubt, that very far from being ac- 
companied or produced by an asthenic state of system, 
it is there where we recognise the highest state of 
inflammation, which rapidly changes and disorganises 
the affected part. Hence, since it is wholly useless to 
maintain that, in the dropsy of scarlatina the curative 
indication is to excite, it rests with the Brunonians 
to say, that it succeeds to the asthenic diathesis, or 



141 



when the sthenic becomes changed into the asthenic : 
absurdities of the system of the Scotcli physician, and 
by errors of observation, confirmed by names other- 
wise illustrious and venerable. And truly, although 
by one of them it is said, that dropsy succeeds to scar- 
latina, from the time when it is treated with repeated 
effusions of blood, we can moreover maintain that 
this is a real error of observation. And in fact are 
not the common people to be pardoned, when they 
believe that dropsy produced by scarlatina, where 
blood has been taken, has succeeded this evacuation 
of the humours? And would it not be the same to 
say, that in one dead of pneumonia, in the course 
of which disease bleeding was employed, that the 
bleeding was the cause of death ? But much more 
just would it not be to judge, that the death in this 
case, and the dropsy in the first, had succeeded from 
the bleeding not having been employed in time, and 
in sufficient quantity, to cut short the inflammation, 
which in one case has produced disorganization in 
the lungs, in the other a secretion of serum ? And 
why is this unfortunate result of the scarlatina in fact 
less frequent in these days than it was formerly, 
unless, that among the more obstinate physicians, 
and those attached to prejudices, which the tyranny 
of the humoral pathology exercised over the vulgar, 
those who are conscientious are getting rid of them, 
and at present use in the cure of the same disease a 
more active antiphlogistic regimen. And if any one 
should be disposed to raise no small difficulty to our 
manner of considering the production of dropsy after 
scarlatina, by saying that it often arises in those who 
are already recovered, we would excite our adversa- 



142 



ries to examine a little more scrupulously the state 
of their patients, from whence they may infer, that 
although in those cases in which the scarlatina ap- 
pears to be cured, the vascular system has not re- 
turned, and that of the integuments especially, to its 
natural condition ; since even the celebrated Frank 
assures us that he saw it arise in those " quibus des- 
quamatio a scarlatina rite peracta non erat." 

We maintain, then, that if the scarlatina is always 
an inflammation, the dropsy also which accompanies 
this disease is undoubtedly an inflammatory process ; 
since it succeeds to all the other forms of exanthe- 
mata; and all that we have already said in re- 
ference to the production of dropsy must be extended 
to that which arises, as we are warned by Frank, 
(whom we have so often praised), " ab aliis quoque 
morbis exanthematicis vix superatis, ut a morbillis, 
atque miMai-ibus." 

Another form of erysipelatous inflammation, which 
frequently precedes, and gives origin to the dropsy, is 
that of the gout and rheumatism, as we have recog- 
nised when treating on this subject, supported by 
daily experience, and by the authority of Hoffman, of 
Musgrave, Sauvage, Boerhaave, and Vanswieten. 
And here, still more, shall we support the confutation 
of the humoral pathology, on which we were occu- 
pied in the same place, examining the form of inflam- 
mation which accompanies gout, on which the hu- 
moralists had truly much to rest, not disturbed by any 
of the most zealous propagators of the theory of ex- 
citability; especially if we take into consideration the 



143 



phenomenon of its alternate production in one part 
of the body and in another. 

But having collected together very many other 
facts similar to these, which relate to other forms of 
disease — seeing all these appertain to simple inflam- 
mation, (however various might be the appearance, 
and the occasional external causes), and more espe- 
cially to that kind of inflammation termed erysipela- 
tous — we were enabled to deduce the expression of all 
these facts, in the event of single cases served to ex- 
, plain them, without rendering it permissible to have 
recourse to any hypothesis of humoral or spiritual 
transference : explanations which, up to this time, 
pathologists could not fail to resort to. On this very 
law, then, established by means of facts appertaining 
to well-known forms of inflammation similar to those 
of gout, (the disease the nature of which we wished to 
establish), together with the analogy of their symp- 
toms, causes, and cure, we were enabled to rest the 
inflammatory nature of the disease 5 declaring in con- 
sequence, that gout was nothing more than a mere 
membranous inflammation, and hence of the nature of 
erysipelas. It remained, then, to give the last blow to 
the hypothesis of an unknown humour as its effective 
cause, and establish our own view in the clearest man- 
ner — to make an accurate examination of the patholo- 
gical results : and among these the serous effusion 
which constitutes dropsy, and which succeeds in the 
different parts to gout, is the principal and most frequent. 

Now, as we have proved, placing beyond a doubt, 



144 



by means of the examination of many other forms of 
disease certainly inflammatory, and which generate 
dropsy, that this serous collection is produced by in- 
flammation : thus also by the same means, while adding 
an argument to the theory of the inflammatory nature of 
gout, we derive another, from the morbid collection of 
fluid produced by this as well as by the other forms 
of inflammation, in favour of the uniformly inflam- 
matory nature of dropsy, and thus observing nothing 
else in this consequence of the gout but a simple 
dropsy, or one of the various processes of inflamma- 
tion, we may et extremas ducere exequias" of that 
unknown arthritic humour, the existence of which 
has been maintained with so much boldness by the 
humoral pathologists. 

Finally, we may add, that gout attacking not only 
the membranous portions of the articulations, where 
it often produces hydrarthus, but, at other times, the 
internal membranes, and the viscera of the human 
body, we have thus another argument to prove that 
the gout is a simple inflammation, and the succeding 
dropsy nothing more than one of the common pro- 
ducts of inflammation, especially membranous, from 
the examination of the other alterations, which, with 
the same serous elfusion, is observed whenever that 
form of inflammation attacks the internal membranes 
— the peritoneum, the intestines, the pleura — the 
membranes of the brain, which (in persons dead from 
gouty metastasis to the interior) are found thickened 
or covered with puriform fluid, or with a layer of 
coagulable lymph, and beneath it are seen either red 



145 



or livid appearances, which are at present believed 
by all the best physicians to be undeniable traces of 
the inflammatory process which has preceded. 

Proceeding to consider the other forms of disease 
which attack the viscera, and which are acknowledged 
by physicians to arise from real inflammation, we shall 
find in all the writers on medicine, from Hippocrates 
to our own times, that among the different products 
of this morbid process they have observed the accu- 
mulation of fluid which constitutes the various kinds 
of dropsy. 

But as even these very forms of inflammation, al- 
though the clearest and most constantly distinct, have 
their development and their progress obscure and 
masked — as, among others, was observed by Stoll, 
and is proved by Wrenhold and by Shroeder, in their 
excellent dissertations on this subject — so it is not to 
be wondered at that they often escaped observation, 
as any one may assure himself, examining critically, 
and with a scrupulous analysis, the cases relating to 
the subject transmitted to us by practical physicians 
and by observers of pathological anatomy, in their 
condemned volumes, and afterwards comparing, at 
one and the same time, their obvious product, dropsy ; 
the cause of which they had sought for by a totally 
different method. 

And truly, only two extreme points for considera- 
tion falling under their observation, in the midst of 
which they saw dropsy — the first regarding some re- 
mote causes, which, moreover, are either accessory 



146 



and independent, or occasioning the hidden in- 
flammatory process in this or that viscus, as will be 
seen when we treat of the causes which physicians 
have assigned as producing this malady; the other 
point regarding the alteration in the viscera, observed 
in the dissection of those who have died of dropsy : 
the opinion certainly was obvious that they found in 
the one and the other the causes generating dropsy ; 
the more so, that in the second they did not perceive 
any thing except chemical or humoral degenerations, 
or error loci, irregularity, or sluggishness of the circu- 
lation, instead of merely inflammatory processes, as 
will be demonstrated in the next chapter, in wiiich we 
shall be occupied with the organic alterations which 
all physicians have observed to accompany the dropsy. 
But the most accurate reasoners ought naturally not to 
be completely satisfied w T ith these, the doubt always 
remaining whether these organic alterations which 
occur, were not an effect rather than a cause of 
dropsy, and the more so, as, often with dropsy, the 
usual visceral degenerations are not found, and vice 
versa. Hence we see some reject, as a cause, the 
disease of the liver, which being in reality the most 
frequently met with in dropsy, was the most fre- 
quently maintained to be the cause of the disease. 
Moreover, it is for these reasons (these two points 
falling under their observation) that some lights of 
truth are found in all the books, in the midst of many 
errors on the cause ; since even Hippocrates says 
clearly, u aegritudines acutas solet sequi aqua inter- 
cus" ; besides very precious observations, of which we 
may say that nature has done every thing towards re- 
vealing the real cause of dropsy; and whilst physicians 



147 



found in all the books of practical medicine, and of 
pathological anatomy, that to enteritis, peritonitis, he- 
patitis, splenitis, succeeded either anasarca or ascites ; 
to pleuritis, hydrothorax ; to encephalitis, hydroce- 
phalus ; they could not recognize inflammation as the 
cause, when this or that dropsy was presented to their 
sight, unless they had been able to distinguish the 
preceding inflammatory process, because it was not 
manifested with the usual decided and marked symp- 
toms. 

But the physicians the nearest our own times, the 
Brunonians, who on this subject ought to be better in- 
structed than the ancients — thanks to the labours of the 
deserving writers of the second half of the eighteenth 
century — although they saw more clearly the visceral 
inflammation which preceded dropsy, yet they still 
believed in the absurd idea of" indirect asthenia," of 
the change (of which they admitted all inflammations 
to be susceptible,) from the sthenic to the asthenic 
diathesis, in order to find a support for their beloved 
theory in asthenia, as the proximate cause of all 
dropsies, until the great master of his art, Pietro 
Frank, following the footsteps of Stoll, cured, as we 
shall presently see, several forms of dropsy with 
bloodletting, and with neutral salts, which the first 
Brunonians strenuously avoided, from which he esta- 
blished that sometimes one of the Brunonian diatheses, 
and sometimes another, may be the proximate cause 
of this disease, not less than of all other morbid ap- 
pearances. 



]48 



CHAPTER IV. 



Examination of the nature of the Fluid of Dropsy, and 
also of that which is naturally exhaled into the dif- 
ferent cavities ; aftemvards of the Organic Alterations 
discovered in Dropsies. 



Valsalva made various observations in reference to 
the nature of the fluid of dropsies, in order to see 
if the difference which existed in it could afford 
any means of determining its origin ; and already 
many believed, with Bonetus, that the limpid fluid, 
either colourless or of a very light tint, proceeded 
from the vessels carrying the lymph, instead of the 
veins, from which was derived the serous fluid, mixed 
with other humours, and of the colour of urine. 

But although some difference in the various sen- 
sible qualities of the fluid of the various hydropic 
patients, is actually admitted by Hoffman, Gmelin, 
Senac, De Haen, Vanswieten, and by Du Verney, in 
bis observations on the subject, published in the Trans- 
actions of tbe Academy of Paris, there is nothing 
conclusive against our views; for besides the reflec- 
tions of Morgagni, arising from the change which the 



149 



fluid taken from the bodies of persons who have died 
of dropsy may undergo in consequence of the longer 
or shorter delay, or from other circumstances attend- 
ing the post-mortem examinations, it is absolutely 
necessary to observe, that this variety in the fluid, 
whether it be drawn from living cases, or after death, 
reduces itself to the colour, being either dark or clear, 
or of greater or less density, and to a greater or less 
quantity of aqueous or albuminous matter, and of 
some salinejprinciple present in it. 

But it may be maintained as certain, that in general 
all these varieties contain albumen, since besides it 
having been observed by the ancients that the fluid 
taken from hydropic patients when evaporated leaves 
a gelatino- albuminous substance, more or less white, 
as is asserted by Sennertus, Boyle, Willis, Etmuller, 
Simson, it is well known , as we have before remarked, 
that treated with acids, coagula are always formed 
in it. 

Now that the presence of a gelatino-albuminous 
substance in the fluid of hydropic patients, demon- 
strated by the coagulability of that fluid, furnishes a 
most important argument in favour of its being a new 
product, and hence an equally strong objection against 
those who regard this disease as a mere increase of 
the natural fluids, is proved by the knowledge that 
this coagulability is not found in the other humours 
exhaled naturally in the same parts of the animal 
machine where dropsy is generated : on this sub- 
ject, in fact, passing over the authority of Sap- 
cone, who says clearly, — " The aqueous vapour 



150 



which exhales from the organ and exhalent arteries 
does not shew (when collected from a healthy body) 
any signs of coagulability whether exposed to heat or 
examined in the natural cavities it is certain that 
Cotunnius has maintained victoriously against Lower, 
Lancisi, Kaaw, and Boerhaave, that the humour 
which exhales naturally from the pleura, the pericar- 
dium, the membranes of the brain, and the tunica 
vaginalis testis, is assuredly not coagulable in its 
nature, which is particularly proved by his observa- 
tions on living dogs : — " Ex vivis canibus (he says) 
in hunc finem dissectis pericardii vaporem quoties de- 
traxi atque ad ignem exposui, toties prorsus in auras 
sine ulla, vel levi crustae specie residua, visus est 
evanuisse the same is said of that fluid, " ex viven- 
tium canum abdomine, desumptus, qui et limpidus et 
recens, et fere inodorus ut labem nullam videretur 
contraxisse, igni expositus, sine ullo discrimine totus 
evanuit; quae sors testium etiam vaginae vapori 
contingit. 

And, in fact, it is on this point that the truth 
must be sought for in living animals, since in human 
subjects it is difficult to exclude the suspicion that the 
fluid may have arisen from disease as often as not : 
hence it is not to be wondered at that Lower, Lancisi, 
and Kaaw, found it to be coagulable ; and so it is, as 
Cotunnius observes, each time that it is found, 
<c praeter naturam adauctus." Hence " patientibus 
hydrocephalon, solet cerebri aut spinse vapor coagulo 
imbui : in pectoris hydrope collectae aquae coagulum 
excipiunt ; nec minus illae quae sive pericardii, sive ab- 
dominis, aut vaginae testium, hydropem constituunt." 



151 



And here it is observable that this illustrious 
writer does not recognise the acquired coagulability 
of these fluids to depend on an increase of the natural 
exhalations, but gives of it an explanation, which, 
although a little too mechanical, supports wonderfully 
our theory of the inflammatory origin of dropsy. — cc Si 
enim, (he says,) ampliora excernentia essent vasa ac 
natura solent, copiosius aquam, unaque crassius serum 
et coaguli capax facile trajicerent uti reapse trajiciunt 
cum auctis vita viribus prseter modum distenduntur." 

We may reflect in passing, that this explanation, 
which is moreover the one which in this medical 
school is given of inflammation, although very inge- 
nious, nor assuredly improbable, yet as it establishes 
a vascular condition which cannot be sensibly demon- 
strated to exist, and against which some facts may 
militate, so it will be sufficient for us to retain that 
portion of it which shews that this morbid collection 
of coagulable fluid is generated by a new secreting 
process from the inflamed membranous surface of the 
part in which it arises. 

To this point truth assists us : if we would go further 
to explain the mode in which it forms, and in what 
consists the inflammation which generates it, we 
should relate only hypotheses, and repeat in a more 
or less neat manner the very same which have been 
already related, since physicians began to write about 
medicine ; and, before quitting this subject, the 
qualities of the fluid, morbidly collected, which con- 
stitutes dropsy, (the most important of which, 
and which distinguishes it from the humours in a 



152 



healthy state, and naturally exhaling from the same 
parts, is the presence of certain substances which may 
he made to concrete,) we shall take leave to make a 
reflection, which, besides demonstrating still more 
its inflammatory origin, may serve to give a con- 
venient explanation of the before-mentioned variety 
in the sensible qualities of the water of different 
dropsical patients ; and this is, that since, in all the 
products of inflammation there is seen in greater or 
less quantity the albuminous matter which may be 
concreted, thus (besides having a strong argnment to 
maintain that the presence of that animal principle in 
parts where it did not naturally exist, indicates a pre- 
ceding inflammatory process) it appears to us to be 
most probable, and we shall goon still further demon- 
strating it in our progress, that in these the difference 
of the quantity depends on a different degree of in- 
flammation, and the different form which those pro- 
ducts assume of aqueous lymph, pultaceous lymph, 
mucus, false membranes, polypous, and osseous con- 
cretions, are owing, besides the various degree and 
cause of the inflammation, to the difference in the 
occasional causes and the nature of the affected parts. 

And in truth also there appears visibly to exist a 
certain gradation in the composition of these effects 
of inflammation which demonstrates an equal relative 
gradation in the severity of the inflammation which 
produces them, since even on the surface of the 
body fluid is seen to collect after a slight inflammation 
and from slight injuries ; the process, on the contrary, 
being severe, when induced by severe or violent 
causes. For which reasons, besides the means of very 



153 



reasonably maintaining that dropsy is one of the pro- 
ducts of inflammation, we may also establish these 
other facts : — 

1. The dropsical fluid, which contains less than in 
other cases of dropsy the principle of coagulable al- 
bumen, is one of the most simple forms, and hence 
the result of a slighter inflammation. 

2. That the variable quantity of the same animal 
principle occasioning the obvious varieties in the sen- 
sible qualities of dropsical fluid, depends, as we have 
already remarked, on the variable degree of inflam- 
mation which has produced it : and is it not shewn 
by the fact that the denser and deeper coloured fluids 
containing a greater quantity of coagulable principle, 
and thus acknowledging a more severe inflammatory 
process as a cause, has induced physicians to declare 
that such a condition affords an unfavourable prognosis ? 

But the morbid inflammatory process which pro- 
duces dropsy in different parts of the animal machine, 
is very often not limited solely to the production of 
fluid which constitutes this disease, but in proportion 
to its severity gives rise also to several other more 
complicated forms of the products of inflammation, 
which are often found at the same time with dropsy. 

And already we have remarked, that from the time 
of the most ancient physicians, different visceral al- 
terations were found co-existent with dropsy : but by 
these little was remarked, except the most obvious ex- 



154 

ternal appearances; hence described by the un- 
meaning appellations of obstruction, swelling, or the 
still more vague word corruption, while their real 
origin was not established, as we have shewn, except 
hy some of the best writers of the second half of the 
past century, and above all by means of the late patho- 
logical investigations of some of the illustrious zoono- 
mists who at present adorn Italy. 

In fact, passing over Columbus, Heintz, Rondelezius, 
Bartolinus, Peyer,Trincavelli, Sennertus, Willis, Piso, 
Zacutus, Riverius, Etmuller, Morton, Littre, Sassonia, 
Plater, Horstius, Tulpius, Ruischius, Bonetus, and 
a thousand others, who in their observations on this 
disease speak to us in the already mentioned language, 
in reference to the organic alterations occurring in 
cases of dropsy, either in the abdomen, or the chest, or 
the brain, we come to the great Hoffman, who leaves 
us nothing better, saying of the liver that "plerumque 
morbidum fuisse repertum, et nunc quidem pallidum 
et fere exangue, nunc tumidum et atrum, tensum, 
schirrosum and of the other viscera, " omentum in 
dissectis ascite defunctis ut plurimum inveniri cor- 
r up turn et sphacellatum vel plane extenuatum et ab- 
suntum, pancreas schirrosum, et mesenterium ob- 
vesicas quibus interius obsidere solet, aqua repletas, 
et glandulas ad fabse magnitudinem tumefactas, in 
magnum molem excretum j" and it is only of the in- 
testines and of the stomach that he expresses himself 
a little better, saying, " neque intestina cum ventricnlo 
reliquuntur immunia ; sed ista observari inflammata, 
giderata et corrosa." 



L55 



We will say nothing of Sauvages, who without 
ever alluding to the inflammatory cause of dropsy, 
assures us, however, that in those dead of this disease 
there are found " viscera plurima nunc hsec nunc ilia 
obstructa, indurata vel etiam remollita, semiputrida, 
callosa, rettorida, granulosa, suppurata, absumpta, 
adaucta et saepissime hepar, dein lien, mesenterium, 
pancreas, uterus, rarius renes, epiploum, pulmones, 
Cor." 

But what has always been to us a subject of the 
greatest wonder, is the attentive consideration of the 
great work of the so much venerated Morgagni, " De 
Causis et Sedibus Morborum," which includes, as in a 
treasury, all the principal and most interesting patho- 
logical observations registered in the preceding im- 
mense works of practical medicine and of patholo- 
gical anatomy. How is it possible not to be astonished 
that he, who in the 38th Epistle — set apart for the ex- 
amination of different dropsies, from the various 
dropsical cases which occurred in the practice of Van- 
salva and in his own, in each of which, both from the 
history of the symptoms and from the organic altera- 
tions occurring with the effusion, it is sufficiently clear 
that an inflammatory process preceded them and accom- 
panied the effusion — does not mention one in which 
he recognises either the pathological alterations or the 
dropsy, as being generated by inflammation ? And, 
in truth, it is very singular how this very celebrated 
anatomist, from the numerous observations which he 
delivers to us, in which at one time one viscus, 
at other times a different one, or one or other of the 
membranes were enlarged, or hardened, or cor- 



156 



rugated, or covered with purulent matter, or adherent 
to neighbouring parts, never speaks to us of the 
preceding inflammation, and still less as of a pro- 
cess producing the disease, and only sometimes treats 
of the inflammation at all of one or other of the vis- 
cera \ and, among the pathological observations which 
are mentioned, the collection of fluid is one in which 
he still more rarely recognises the preceding inflam- 
mation of the parts in which it occurs. 

Thus it is not until the 20th Epistle, in which, (after 
having erroneously maintained that in the three cases 
of pneumonia registered under the Nos. 30, 32, 33, in 
which fluid was found in the chest, that it was indepen- 
dent of the visceral inflammation, and even had pre- 
ceded it,) he says clearly, following Coiterus, that 
sometimes dropsy of the chest maybe generated at the 
same time with pleurisy and pneumonia. But behold 
the beautiful explanation on the cause of dropsy which 
has been left us in this case by a writer on whom so 
many encomiums have been heaped. " Quod si huic 
inde, et sanguinis per pulmonum vascula circumitio 
retardetur, et humoris ex intima asperae arteriae, exti- 
maque totius corporis superficie invisibiles quidem sed 
innumerse jugiter prodeuntes particulee cohibeantur ; 
ha? per aliaaliarum membranarum foraminula exitum 
molientur, earumque praesertim, quae magis tunc ca- 
lentes, magis quoque patulos, habebunt poros, hoc est 
thoracem intus, ej usque viscera convestientium." 
But do not all the phenomena, visibly manifested 
in inflammation, shew something different from re- 
tardation of the circulation? and what afterwards shall 
we say of the explanation borrowed from the physi- 



157 



cal properties of inorganic bodies, that dilatation 
of the pores has reference to the high temperature of 
the part ! 

Finally, that which most deserves to be mentioned 
by us, in reference to this highly prized work, and 
which places beyond dispute our theory on the for- 
mation of dropsy, is, that of more than two hundred 
cases enregistered in it, of aqueouscollections occurring 
either in the thoracic, abdominal, or cerebral cavi- 
ties, all present at the same time either thickening of 
the membranes, or hardening, or tubercles, or ulce- 
rations, or steatomatous concretions of the viscera, or, 
above all, adhesions of some viscus or membrane to 
the adjacent parts, either directly or through the me- 
dium of new fibres and false membrane : all altera- 
tions, the inflammatory origin of which, although even 
to these days so little known, is now maintained by 
the best modern physicians; thanks to the labours of 
Wrenholt, of Shroeder, of Frank, and especially of the 
Italians, Tommasini, Rasori, Rubini, Pisani, which 
will be demonstrated in the second part of this work. 
For this reason we do not think it necessary to stop 
long, in confuting the idea— which, however, is found 
in all medical books, and even of those nearest our 
own time — that these described visceral alterations 
are produced by the "stasis" of the water; on which 
point, moreover, to render the fluid fit for the pur- 
pose, it was necessary, from the time of the old physi- 
cians, to imagine, that it was impregnated with 
sulphur and salts, which, with their poignancy, ren- 
dered them more acrid, pungent, and corrosive; ideas, 



158 



the plain absurdity and ridicule of which, the ever- 
dominant humoral pathology did not permit to be 
exposed. But at present that this system has lost 
no little of its tyranny over the mind, we cannot be- 
lieve that there is any physician of good sense, who 
(since in practice we see individuals who have been 
afflicted with dropsy during many months and years 
become cured, either by appropriate treatment, or 
even without any assistance from art), is not capable 
of making the obvious reflection, that if the stasis of 
the fluid was the occasion of the visceral alterations 
met with in this disease, how would it be possible to 
effect a cure and a return to good health, after so long 
a delay. Hence we cannot participate in the astonish- 
ment of Vanswieten, in reference to that lady, who, 
after three years of an immense ascites, Mead having 
extracted by puncture sixty pints of fluid, " nunquam 
rediit hydrops, et elapsis decern mensibus filium ro- 
bustum perperit, plurium postea prolium fsecunda 
mater." 

Nor in truth do we fear either the objections of any 
one who might pretend that sometimes the viscera 
in persons dead from dropsy are found healthy, and 
instead the lymphatic vessels turgid, or the authority 
on which this might be based. In the meantime 
behold the principal observation of Valsalva on this 
point, which Morgagni gives us as those on which he 
believed he had sustained the proposition. 

" Foemina viginti sex circiter annorum quae uterum 
non semel tulerat, post animi perturbationes to to cor- 



159 



pore leviter, abclomine magis intumescit, difficulter 
et erecta respirat, neutrum in latus laboriose de- 
cumbit, ingens in thorace pondus percipit, maxime 
sitit, donee difficultate spirandi ingravescente, mor- 
tem obiit. In ventre pauca erat aqua, sed ventri- 
culus praeturgidus etbepar magnum adeo diaphragma 
sursum pellebant, ut thoracis cavea minor fieret. 
Ceterum lymphae ductus turgebant in ventre, cuncta- 
que hujus viscera bene se habebant, si indurata exci- 
pias ovaria, thorax omnino aquae plenus. Pulmones 
non nihil duri, et rubri, variisque maculis nigris dis- 
tincti, caetera sani." 

And is it not sufficient to get rid of the most blind 
veneration for such great names, to discover that 
errors of observation are not altogether foreign to 
them. And, in fact, if any one can go so far as to say 
that all the viscera of the belly are healthy, after 
having stated that u Ventriculus perturgidus et hepar 
magnum adeo diaphragma sursum pellebant, ut tho- 
racis cavea minor fieret," if it be asserted, as a trifling 
and inconclusive alteration of the lungs, when they 
were found iC duri, rubri, variisque maculis, nigris 
distincti," what can we ever relate or believe to be 
true, or exact, or precise, grounded on their judgment 
of the healthy or morbid condition of the parts. 

If, then, after the accurate examination of the post- 
mortem observations noted by the most illustrious 
writers on practical medicine and pathological ana- 
tomy — nor less of those which all physicians have a 
daily opportunity of making in the bodies of those 



160 



who die of dropsy — we gather, that almost always or- 
ganic alterations are met with, in this or that viscus, 
which indisputably demonstrate that they have been 
preceded by a pathological process, inflammation, may 
Ave not faintly flatter ourselves that we have brought 
to light a very strong argument in favour of our theory 
of the inflammatory cause of dropsy ? 



161 



CHAPTER V. 

Of the Method of Cure pursued in all times, although 
not always in accordance with the different Theories 
of the Schools. 



By the attentive study of the best works on medicine, 
from the time of Hippocrates to our own days, it is 
easy to observe, that in the midst of so many erro- 
neous ideas left us on the origin of Dropsy, in propor- 
tion to the different theories which, in various times, 
ruled the various medical schools, the method of cure 
resolved itself always into evacuation of the animal 
humours ; to which were added, by some physicians, 
powerful means to increase the activity of those or- 
ganic functions which maintain nutrition, and the 
necessary harmony of parts. 

And physicians were doubtless led to the evacua- 
tion of the humours, from having all observed, as Van- 
swieten remarks, " naturam sa?pius banc viam indi- 
care in sanando hoc morbo." 

Hippocrates, in fact, had before observed: — 

" Hydropicis secundum venas aqua in alvum pro- 
rumpeute solutio fit (Coac. prsenot. n. 467). Hydropi 
incipienti alvi profluvium aquosum superveniens citra 

M 



162 



cruditatem morbum solvit (Coac. prsenot. n.457), spb- 
aquoso etlienoso, albaque pituita detento alvvis vehe- 
menter, perturbata, bonum (De Morbis, lib. i. c. 4, 
et aphorism 29, sect. 7)? which orders the dropsical 
patient, if naturally " non purgetur, medicamentum 
dehorsum purgans, quo aqua purgetur exhibito, (De 
Morbis, lib. ii. c. 28) ; and in another place, tc si alvus 
sponte turbata non fuerit, cucaro dato, aut hippophae, 
grano gnidio, vel magnesio lapide purgare oportet. 
(De Inter. Affect, c. 22.) 

And here it must be remarked, that not only does 
he wish to evacuate the humours by the belly, but also 
by the cutaneous transpiration, since in the last place, 
whilst prescribing for the diet substances proper to 
excite the circulation, and increase the proper nutri- 
tion of parts, he orders, moreover, that the patient 
should walk twenty or thirty stadia per day : and 
the book, "De Vict. Ratione in Morbis Acutis," whe- 
ther it be or be not by Hippocrates, clearly re- 
cognizes also the evacuation of blood as a means of 
cure in dropsy. " Quod si difficultate spirandi tenea- 
tur, anni tempus aestivum fuerit, aetas vigeatet virutn 
robur adsit, sanguinem ex brachio detrahere conve- 
nit." Nor does he pass by the operation of para- 
centesis, saying — " Si igitur medicamentis et reliqua 
victus ratione juvetur et venter molietur ; sin minus, 
sectione facta, aquam educere oportet, (De Affect, 
sect. 1, 6.) 

This method of cure by evacuation served as a rule 
to the Greek physicians, both ancient and modern, 
and even the best of these, Alexander Trallianus, is 



103 



seen manifestly to incline to, as well as to recognize, 
the inflammatory origin of dropsy, in the use of the 
evacuating treatment, saying openly, that " nullum 
valde calefaciens jnvare potest, nam ejusmodi medica- 
menta situm ipsorum (hydrope detentorum) augent 
et febrem intendunt, et cansas inflammantes, magis 
adhuc exnrunt intenduntqne malum." Hence he 
had no difficulty in ordering bloodletting ; as was 
also the case with Paulus iEgineta. 

Celsus, in his cure of dropsy, recommends evacu- 
ating remedies ; above all of which, he praises the 
squill, and likewise lays much stress on exercise, 
frictions, and the hot bath, especially the sand bath, 
which, commended by all the physicians of the metho- 
dical sect, it must be seen cannot be of utility in 
many cases, except by the abundant perspiration 
which follows its employment. 

But this work would swell into an immense volume 
if we were to report the method of cure which is 
found described in the great series of the works of the 
Greek, Latin, and Arabian physicians ; nor do we think 
it convenient, inasmuch as any one, by the study of 
the same, can easily convince himself that the most 
active part of their treatment, all-complicated and 
contradictory as it was in this disease, not less than 
in many others, was always by evacuating the animal 
humours, by means of the use of emeto-cathartic re- 
medies—diuretics and diaphoretics. In the same way, 
we shall say nothing of those physicians, who, at the 
resurrection of science, re-established the Greek 
physic, which, for this very reason, could not be difte- 



1C>4 



rent from the former ; and, in fact, the same is found 
in the cases of dropsy which we meet with here and 
there in the many hundred of practical observations 
collected and transmitted by the observers of the six- 
teenth century. 

Also we shall say nothing of the chemical physi- 
cians, it being well known to all that their most pow- 
erful medicines were violent evacuants, which could 
not be otherwise, being preparations of antimony and 
mercury, of whose miraculous efficacy they boasted 
so much : and, in truth, although we are far from 
lending our faith to the vain-glorious Van Helmont, 
who says, " Se supra bis mille hydropicos, etiam 
quod lotium jam ex cruento inquiaret, et tota nocte 
vix uniira cochleare minxerant, in pristinum sanita- 
tem restituisse nevertheless, no one can assuredly 
deny that those physicians were very fortunate in their 
cure of dropsy, and had effected cures, surprising and 
miraculous, among other physicians : nor shall we 
occupy ourselves with the modern Iatro chemists and 
Hippocratists, since from their theories, which we 
have before glanced at, we can easily understand how 
their curative method must have been to evacuate the 
animal humours. Such, in fact, was that of Willis, of 
Sennertus, of Piso, of Etmuller, and Riverius, and 
many others. In reference to this last, it may not be 
useless to observe, that of the fifteen or twenty cases 
of dropsy, related by him among his own observations, 
or those of others, there was not one in which, while 
it was impossible not to recognize clearly that the 
collection of fluid was the sequela of synocha, of 
puerperal disease, of acute or chronic inflammation, of 



16.) 

the spleen, liver, and lungs, &c, we do not see also 
in the formulae of medicines, with which the patients 
were treated, a decidedly evacuating treatment, con- 
sisting of mild or drastic purgatives, diuretics, and 
diaphoretics. 

But in reference to Sydenham, it is very well worthy 
of remark, that having maintained a defect in sangui- 
fication to be the cause of dropsy, and although the 
theory would lead him to a totally different practice, 
the first indication of cure laid down by him is the 
evacuation of the water, to effect which he makes the 
most courageous use of drastics, of emetics, and of 
diuretics ; and still further, after having fulfilled the 
first indication, he lays it down for the second to give 
corroborants, nevertheless believing it to be neces- 
sary only with aged patients, or those " qui alios minus 
sani corporis habitu sunt praediti while young pa- 
tients u aquis rite expurgatis, sine alio quovis prsesidio 
convalesca^.'' To which, if we add the reflection that 
in fact in all cases of dropsy reported by him no other 
treatment except by evacuation is reported, any one 
may easily deduce, even from the observations of this 
illustrious writer, the truth of the ideas which we are 
explaining, of the origin and cure of this disease. 

In pursuing the subject, we have seen that a precursor 
of the theory and practice of Brown was certainly 
found in Ludwig, who having established the general 
debility or atony of vessels and of the whole animal ma- 
chine as the primary cause of dropsy, decided that " vera 
medendi ratio ad sola roborantea ducit." But here 
we must observe that although this author, according 



to his preconceived theoretical idea?, declares himself 
opposed to purgatives in the cure of this disease, he 
uses many other evacuants, sudorifics, and diuretics, 
among which he praises especially the squill, in 
which it appears to him, " invenire stimulum aliquem 
efficacissimum and in regard to the vital action of 
this medicine, it is singular to see how nature would 
almost per force convince him of his error, and reveal 
to him the opposite truth. " Tentavi quidem," he con- 
fesses, "scillee connubium cum roborantibus et infuso 
corticis peruviani concentrato aliquam scillae partem 
addidi ; sed tentamina ha?c semper inania fuerimt." 
But what avails, (i when caecutire volunt?" 

Now see the explanation he gives of this : " Prop- 
teria quod robur solidorum nunquam nisi post evacua- 
tiones consuetas non nihil auctas instaurari potest," 
which is as much as to say, by way of removing de- 
bility it is necessary to debilitate the patient more 
by evacuations. 

The same reflections we may repeat in reference to 
Milman and Vogel. The first of these, whilst in his 
explanation of the origin of dropsy, he attaches him- 
self, as we saw, especially to debility, that is, "ad fi bra- 
rum laxitatem ad vires magnis evacuationibus, mor- 
bisve auctis in longum protractis, demissas" — to which 
he adds, " Impeditum revolubilem sanguinis cir- 
cuitum" — nevertheless confides the cure princi- 
pally to evacuants, and " quidem drastici," as the 
pills of Bacher, so much praised by him. Even in 
the observations of dropsies reported by him, while 
they demonstrate evidently the preceding and accom- 



167 



panying inflammation, the method of cure is seen to 
have been actively evacuant, since he did not omit 
even venesection, in spite of slipping in some exciting 
potion in the midst of these heroic purgatives. And 
Vogel — who preferred restricting the idea of atony as 
the cause of dropsy to the lymphatics, without giving 
himself the trouble to explain how the evacuative 
means which he suggests relieve the condition laid 
down by his theory (which he would have found not a 
little difficult), follows the physicians of all ages, " et 
ipsum naturae ductum;" saying that " purgantibus 
imprimis ac diureticis, scorsim et conjunctim interpo- 
sitis tonicis exequenda est." 

Finally, also, the most powerful defender of atony, 
the graceful reformer of the theories of Hoffman, the 
celebrated Cullen, after having established these three 
curative indications on the theory of dropsy — 

1 . To obviate the remote causes of the disease ; 

2. To evacuate the accumulated serum ; 

3. To excite the energy of the system ; — like all other 
physicians he lays the greatest stress upon the second, 
which he says he is satisfied of effecting by determin- 
ing serous excretions, by means of which the absorp- 
tion in the diseased parts is re-excited. 

But to purge, to evacuate the humours by the sto- 
mach, the intestines, the kidneys, or the skin, was the 
principal curative indication of Quaun, De Haen, 
Storch, Borsieri, and, above all, of Casimir Medicus, 



168 



and Stoll, by whom the antiphlogistic method 
was courageously adopted, not even omitting vene- 
section. When the great system of Brown ap- 
peared, according to whom dropsy ought to belong to 
the class of diseases of the asthenic diathesis, fanatics 
began to disclaim against the common antiphlogistic 
method, and employment of salts which produce 
evacuations. 



169 



CHAPTER VI. 

Explanation of the Cause of Dropsy, taken from the 
preceding Chapters. 



Reconsidering for the moment the materials de- 
rived from the preceding observations, it is quite 
clear that we have discovered five most important 
facts : — 

1. That the collection of fluid constituting dropsy, 
in the different parts of the animal machine, is most 
similar, both by its sensible qualities, and from the 
principles detected in it by chemical analysis, to that 
which we see produced on the surface of the body, 
whenever certain forms of inflammation, produced 
either artificially or naturally, are developed there ; 
and hence, that the collection of this last, whenever 
produced under the epidermis, may be considered as 
a true cutaneous dropsy. 

2. That the fluid of dropsy is, on the contrary, 
wholly different in its component principles from the 
fluid which naturally exhales in the different cavities 
of the animal machine. 



170 



3. That among the productions of inflammation 
which attack the different parts of the body, dropsy is 
the most frequent, (principally speaking of erysipela- 
tous inflammation), is demonstrated by the practical 
and anatomical observations of all the greatest writers 
of ancient and modern times, it having been seen 
always as at present that the anasarca, ascites, hydro- 
thorax, and hydrocephalus, were generated by vis- 
ceral inflammations ; and above all by inflammations 
of the skin or membranes. 

4. That in all patients who die from dropsy, from 
whatever remote cause it may be supposed to have 
proceeded, organic alterations are always found, ir- 
refragably demonstrating a preceding inflammatory 
action. 

5. That the principal method of cure, and the most 
successful, pursued in all times, was always to pro- 
mote the secretion and evacuation of the animal hu- 
mours ; and, in some cases, at the same time to 
increase the activity of the functions of organs which 
maintain the necessary nutrition of parts : hence that 
from the exclusive use of stimulants, properly so 
called — wine, spirits bark, aromatics, no one has ever 
succeeded in curing dropsy. 

Now adhering to the facts of the first class, we 
can establish first of all, that in order to constitute 
this disease, the dropsy, it is not necessary that the 
morbid collection of fluid should be formed in the ca- 
vities, or quasi cavities of the human body, as all the 
modern works, even the most recent, on medicine and 



171 



surgery, affirm ; that is, where naturally a certain 
vapour is developed, and perhaps condensed in part 
in the form of a little water, which is always being 
dissipated by means of the absorbents, and regenerated 
by the vascular extremities of the exhalent arteries. 
In fact, when the aqueous collections are formed, as 
we have seen, between the epidermis and the skin, 
can any one imagine a cavity between them in their 
natural state ? If, then, any part of the animal ma- 
chine, hollow or not hollow,' separating or not sepa- 
rating that natural humour, is susceptible of dropsy, 
the idea universally put forth, that dropsy consists in 
a merely exuberant collection of the humour naturally 
exhaling from the membranous surfaces of the in- 
ternal parts of the body, begins to be esteemed 
false : an idea the erroneous nature of which is de- 
monstrated to the plainest evidence by the facts ap- 
pertaining to the second class. Instead of this, who 
does not see, both from the first and second reasons, 
that it must be admitted as incontestible, not only that 
dropsy depends on a collection of fluid, which did 
not exist before, or on a new morbid secretion, which 
the vessels of the surfaces of the part in which it 
commences, form, but also, that the morbid state 
which renders them capable of producing this 
dropsy is inflammation. And in truth, from these 
two classes alone of facts, we might with sufficient 
reason have established the truth of the theory of the 
formation of dropsy ; but we wished to have other 
arguments, and we have found them in the examina- 
tion of the three other classes of facts which occupied 
our preceding investigations : the last of which will 
suffice to establish also the true theory of the cure, 



r 



172 



and consequently the curative indication, which in- 
cludes all the facts contained in the history of me- 
dicine, confirmed by the practice of other physicians. 

Hence in reference to the production of this dis- 
ease, each will see not only demonstrated our theory 
of the universally inflammatory cause of dropsy, but 
that all other causes remain excluded, because con- 
tradicted by one or other of these classes of facts. 

And this last consequence we should altogether 
abandon to the perspicuity of our readers, as we do 
all the theories anterior to those of the Scotch physi- 
cian, Dr. Brown, if the too notorious opinion of this 
reformer, and its modifications in the present day, did 
not oblige us absolutely to occupy ourselves with the 
consideration of it. 



173 



CHAPTER VIII*. 

On the false opinions commonly put forward, from 
errors of observation on the remote causes of 
Dropsy, 



Do, then, the dropsies commonly believed to succeed 
to debilitating causes, depend on inflammation ? 

Here let us be permitted to institute an impartial 
and candid examination of those causes, called occa- 
sional or predisposing, which hitherto all physicians 
have entertained. 

First behold that of Boerhaave, which it will be 
quite sufficient to mention here, because it may be 
seen copied in all other books of theory and practice 
of medicine. 

" Dispositio gentilitia: potus nimius frigide sum- 
tus neque vomitu, neque alvo, neque sudore vel urina, 
calore, motuve excitatis excretus : morbi acuti, in 
primis ardentissimi, sive cum site potuque inexplebili 
sive sine his : dysenteria lienosa, diu permaneus : 
omnes pertinaces viscerum obstructiones, ut scirrhi 
hepatis, lienis, pancreatis, mesenterii, renum, uteri, 

* The Seventh Chapter is omitted, as consisting entirely of 
arguments against the Brunonian theory. 



174 



intestinorum : icterus : quarlana sa?va et podagra : 
evacuationes qusecunquc nimise, maxime sanguinis 
arteriosi : haustus acrium, fermentatorumque liquo- 
rum : victum tenacium, durorum : hydatides in- 
gentes, plures in cavo abdominis pendulae, et plura 
similia ut melancholia, scorbutus." 

Who does not see us borne out in what we asserted 
in another place, that all physicians had held, as 
causes of dropsy, only those effects which accompany 
it, and of causes also which neither dispose to, nor 
occasion it, but can alone be the occasional and pre- 
disposing causes of the first pathological process which 
generates it. 

And respecting the hereditary disposition to this 
disease, (which we might think complimentary to 
Boerhaave to enumerate as a remote cause, although 
indeed it received but very little support from his 
accurate commentator Vanswieten, in bringing for- 
ward the superstitious custom of which Plutarch 
speaks, regarding the sons of persons dead of dropsy 
bathing their feet in the water of the ascites, 
at the burning of the corpse, under the idea of 
protecting themselves against the disease), it must 
be remembered that even were it established by 
decisive observations, it presents no obstacle to our 
doctrine : for on this subject the same observa- 
tion may be made on dropsy as on phthisis, which 
is, that as such an organic disposition of the viscera 
may be inherited as to render the patient more 
easily attacked by inflammation, so this inflammation 
may be disposed to produce dropsy rather than any 



175 



other consequence of inflammation ; otherwise it is 
altogether erroneous, and not conformable with ac- 
curate reasoning, to say that dropsy recognises here- 
ditary disposition as an occasional or remote cause. 

Frank, moreover, does not much believe in this he- 
reditary predisposition, but proposes instead, sex, age, 
and certain employments, as occasional causes : — 
saying, " Attentionem meretur in hydropem dispo- 
sitio sexus fceminei, foetus in utero, setatis infantilis, 
senilis, hominum litteratorum, artificium vitam seden- 
tariam agentium." 

And here, indeed, although it is evident that there 
is no other foundation for this than as it were arises 
from the inheritance of the Boerhaavian and Cullenian 
philosophy, we may make an observation similar to 
that on the hereditary disposition, viz. that in one or 
other sex, at one or other age, there may be a dispo- 
sition to receive an inflammatory action more dis- 
posed to end in dropsy than any other of its termina- 
tions ; since, in fact, when women and young children 
are attacked by inflammation, it is for the most part 
of the erysipelatous kind ; but never can it be said 
rigorously, that sex and age are predisposing causes 
of dropsy, as also by no means are certain occupa- 
tions. And it was only to sustain some humoral, dy- 
namic, or chemical theory, that it was asserted, that 
stone-cutters, tailors, shoemakers, weavers, stove- 
makers, fishermen, and washer-women, were more 
subject to the disease than others. And although 
Ramassini says of millers : — " Non paucos asthmaticos 
factos, ac tandem in hydropem lapsos observavi," it is 



170 



quite clear that neither the flour nor the powder, to 
which he attributes it, can give occasion to the dis- 
ease, except by giving origin to inflammation of the 
viscera of the chest : nor does it produce a greater 
difficulty, the asserting, with Zacchia, that gardeners 
are subject to dropsy, when it is impossible not to 
see, in their habits and the nature of their labour, an 
abundant source of causes occasioning slow inflam- 
mation of the viscera of the abdomen and the chest. 

In reference to infancy, it is unnecessary to notice 
how much the dropsy in the foetus depends on in- 
flammation ; it being well known how much it is ex- 
posed to suffer from injuries or wounds inflicted on 
the mother. 

On cold drink we agree entirely with the excellent 
observation made by Frank, when he says : — " Mor- 
bos alios quidem, sed minime hydropem nisi secunda- 
rium ex illis oriri videmus and when it occurs it 
probably depends on enteritis or some other visceral 
inflammation, which practitioners have often seen 
succeed to copious draughts of cold fluids, " post 
aestum majorem." 

We shall say nothing here of acute diseases, inflam- 
matory fevers, visceral membranous inflammations, 
and the exanthemata, as causes of dropsy, having had 
our attention occupied with these diseases in another 
place. Instead of this, it will not be altogether use- 
less to consider a little the dysentery, because many 
have believed that, in the progress of this disease and 
in other profluvia, they have found a most serious 



177 



objection to our opinions on the cause and formation 
of dropsy. 

And here we must first observe, that Frank, in his 
much lauded observations on dysentery, shews that 
he really understood the nature of the disease, since 
he describes evidently, inflammation of the intestines. 
But he would not undoubtedly have injured the result 
of his labours, if he had avoided modelling them on 
the abstract classification of Brown, and if he had not 
mingled with inflammation a theory imaginary in 
itself, and repugnant to the doctrine of inflammation — 
the asthenic diathesis ; and had he not done so, he 
would have undoubtedly acknowledged that when 
dysentery is supposed to have passed into such a 
condition, nothing has occurred otherwise than the 
establishment of organic disease produced by inflam- 
mation. 

Let us pass over his other error in believing " eflfec- 
tus dysenteria? frequens, inflammatio diversae indolis, 
intestini recti, aut coli erysipelacea, interdum pro- 
fundior est while in fact, instead of the morbid se- 
cretion, and the mucous evacuations of the intestines, 
which were called dysentery, these are in fact the 
consequence of inflammation of the intestines, pro- 
duced either by miasmata, or some other external 
cause. Hence there is nothing wonderful in the 
spreading of this inflammation even to the external 
surface of the intestines, or, in very severe cases, to 
the whole of the abdominal and even the thoracic 
viscera, as may be collected from the observations of 
Dr. Pisani, in his excellent work on the Epidemic 

N 



178 



Dysentery which existed in the Military Hospital of 
Mantua, in the years 1811 and 1812. 

We shall say nothing here on visceral obstructions 
as causes of dropsy, because we have already pointed 
out that we shall prove in their proper place that 
these are simply the effects of inflammation, in the 
same manner as all other organic degenerations are. 
Hence we may maintain, that when they are found 
with dropsy, they are only the effect of one original 
pathological process, and that they accompany dropsy, 
but are not the causes of it : and the same may be 
said of jaundice, which every body knows to be most 
generally one of the symptoms of either acute or 
chronic hepatitis. 

And in speaking of these organic alterations, sup- 
posed to be the causes of dropsy, it will be as well, 
lest any should hope to oppose our doctrine in re- 
ference to the diseases of the heart, from which may 
be inferred the impediment to the free course of the 
blood as a cause of dropsy, and hence an objection to 
the universality of our doctrine of inflammation, to ac- 
knowledge before hand, that we shall demonstrate all 
these alterations to proceed from inflammation attack- 
ing the heart and great vessels, which either renders 
their structure so soft that dilatation succeeds, or, on 
the contrary, thickening and hardening the parietes ; 
or causes the effusion of coagulated lymph, which 
produces the adhesions, the fringes, or the concretions 
called polypi, so variously described by authors on pa- 
thological anatomy : hence nothing will be more 
obvious than that inflammation attacking also the 



179 



pleura, the mediastinum, and the pericardium, should 
give origin to the dropsy which accompanies these 
affections. 

And it is easy here to resolve the question pro- 
posed by Frank, speaking of the sudden starting, with 
pain and agitation, which accompanies hydrothorax, 
and which he recognises as a symptom of many dis- 
eases of the heart — whether this ought to be con- 
sidered as a cause, or rather an effect of dropsy, when 
observed at the same time with it : we answer, that 
neither is this an effect of such diseases, nor those dis- 
eases resulting from it, but both the disease and the 
symptom owe their origin to one and the same cause. 

But in reference to the discharges of blood, which our 
adversaries consider as victorious arguments against 
our opinion, what would they have ? Hildanus cites 
a case of a dropsical patient, in whom epistaxis oc- 
curred, and who lost four pints of blood: — "Non 
tantum vires redierunt, verum etiam ab hydrope citra 
ullorum aliorum remediorum usum brevi curatus est 
8eger.' , Besides, how happened it that the soldier, 
in whom the thyroid artery was wounded, (and was 
saved by my excellent friend Palizzini, by means of 
large bleedings), did not become enormously drop- 
sical ? and in the case of the other soldier, reported 
in Brugnatelli's Journal, who, after a wound of the 
carotid artery, lost twenty-five pints of blood, imagine 
what happened,— a sudden and extreme wasting of 
the body ; that is to say, an extreme increase in the 
inhalent vigour of the absorbents, or in other words, 
a condition exactly opposed to that which permits the 



180 



formation of dropsy. And are there any physicians 
who have not seen patients labouring under aneurism 
have their lives protracted during no short space of 
time, by bleeding, repeated often during the month, 
without any dropsy supervening ; and if such dropsy 
should have succeeded, will they deny that, on the 
post-mortem investigation, undoubted traces of in- 
flammation, either of the thorax or abdomen, were 
visible ? And if this be true, are we not authorized to 
consider simply loss of blood, as a cause of dropsy, to 
be altogether hypothetical, and even impossible. But 
our opponents will say, do we not see dropsy every 
day succeed acute diseases treated by large bleeding ? 
Yes, certainly, and also after uterine haemorrhage, from 
protracted or difficult labour, after haemoptyses, &c. 
But when dropsy succeeds after bleedings in inflam- 
matory fevers, or visceral inflammation, what phy- 
sician is so dull or short-sighted, as not to conclude, 
as we have otherwise observed, that the dropsy su- 
pervened, not in consequence of the evacuation of 
blood, but because it was ordered late, and was in- 
sufficient to stop the inflammatory condition ? 

And in the acknowledged cases of haemorrhage, 
after which we allow that dropsy is developed, who 
can deny that an inflammatory condition in this or 
that part may be discovered by an attentive physi- 
cian ? And does not this occur because inflammation 
is going on in these cases of haemorrhage, to which 
dropsy succeeds ; while the latter disease never oc- 
curs after vast losses of blood occurring suddenly, or 
naturally from external causes ? And finally, who 
does not perceive in this an answer to the very just 



181 



question of Lister, who, when relating the case of a 
lady attacked by dropsy after a severe cough and 
haemoptysis, and who had been freely bled five 
times — which dropsy he attributed, according to the 
received opinion of physicians, to the loss of blood — 
wonders much how it happens that dropsy scarcely 
ever succeeds to natural loss of blood, however co- 
pious, from the uterus, from haemorrhoids, from the 
nostrils, or from wounds in any part of the body, but 
on the contrary, often follows losses of blood which 
occur in the progress of disease ? 

But in reference to the abuse of spirituous liquors, 
facts obliged all physicians to admit it as a remote 
cause of dropsy, although in truth it embarrassed not 
a little the theory of Sydenham, and Morton, and 
Lister, and Cullen, and also other writers. But 
on the appearance of Brown's doctrine, every one 
thought they had dispersed all clouds, and with the 
game of imaginary, direct asthenia, easily understand 
how dropsy might be produced by substances essen- 
tially stimulating, and hence become indirectly asthe- 
nic, in a disease esteemed on first principles directly 
sthenic. And that dropsy is often of this type, even 
the celebrated P. Frank does not hesitate to affirm, to 
explain how " bibacissimi quique helluones saepius 
ex hydrope, quam caeteri mortales conflictantur." 
But we, who maintain with the.last and best reformers 
of the doctrine of excitability, that stimuli can never 
directly induce a weakness of motion, or in their 
sense asthenia, at least as long as the part retains its 
organization — we really believe that we are not wan- 
dering from the truth, in believing that the abuse of 



182 



spirits is not the immediate cause of dropsy, even 
sthenic, because we have seen that the diatheses of 
Brown and others are two abstract conditions, inap- 
plicable and contradictory to the facts to explain 
which they are applied : but that truly it occasions 
the slow abdominal inflammation with which all hard 
drinkers are at length attacked, and that these inflam- 
mations produce the watery collection which consti- 
tutes dropsy. 

Finally, no one will oppose the dropsy which suc- 
ceeds intermittent fevers as an obstacle to our theory 
of its formation ; for in this respect the first practi- 
tioners will agree with us in admitting, that most 
frequently some slow and occult inflammation is pro- 
gressing in one or other viscus, under the appearance 
of a rebellious and obstinate intermittent, demon- 
strated by the solid swellings which often arise, and 
which many have attributed to the bark ; which is 
true, but only in this sense that the use of the bark 
fostered (as in one way was the opinion of Baglivi) 
that inflammatory process which produces the dege- 
neration of the organ, erroneously called solid swell- 
ing or obstructions. It is not either the ague or 
the solid swelling which produces the dropsy, but 
only the primitive pathological process, inflammation, 
working with the ague in one or other part, and 
being increased by the administration of the bark> 
which generates both the dropsy and the before-men- 
tioned visceral changes. Hence let us conclude with 
the celebrated Giannini, " that a physician could 
never live free from remorse, whose patients in tertian 
ague, treated with bark, die or become dropsical." 



J 83 

Lastly, in reference to hydatids, which are enume- 
rated by physicians amid the causes of dropsy, we 
must reflect that if these are animals they have no- 
thing to do with dropsy, and even when collected 
together into a mass, they form a morbid abdominal 
swelling, undoubtedly this cannot be considered as 
an ascites. If they are not animals, as we believe with 
Frank, it may be maintained that these vesicles are so 
many dropsical cysts, but not that they can ever be the 
cause of true dropsy. And on their production, who 
does not see that he is not wandering from the truth, 
when he thinks that they also, in the same way as 
other cysts, owe to inflammation the process of their 
formation ; and that the variety of their structure, and 
of the substance contained in them, whether it be 
serous, or albuminous, or ichorous, or the consist- 
ence of honey, or similar to adipocire, only arises 
from the different nature and severity of the inflam- 
mation, and its causes, and from the various organi- 
zation of the parts in which they are formed ? 



184 



CHAPTER IX. 

Examination of the thirst and toasting which accompany 
Dropsy. 



Two symptoms which the most frequently accompany 
dropsy, are thirst and wasting of the body ; hence in 
treating of this disease it is impossible to avoid inves- 
tigating their causes, the more because the question 
concerning the thirst, which is in fact very obscure, 
has not been decided either by physiologists or patho- 
logists. 

Commencing always with the method hitherto scru- 
pulously observed in our practical and pathological 
researches, and which appears to us most conformable 
to the dictates of Bacon, we shall first examine all the 
facts most important in throwing light on that patho- 
logical condition in which living beings are often 
found, and which being perceived by the animal, is 
called thirst. Now, of these facts, some lead to the 
final cause, others to the discovery of the physical 
cause, or the organic condition in which it consists. 

Among these are the profluvia of the various animal 
fluids, during which either a greater or less degree of 



185 



thirst occurs. Of these especially, the diabetes, (of 
which Frank well said, that it was " vera corporis per 
urinam colliquatio)," presents in a terrible manner, 
in a greater degree than any other disease, the 
symptom of thirst. " Prima (says this great author) 
quae in diabeticis quos vidimus occurrebant, et ex 
improviso plerumque hominem prehendebant, symp- 
tomata, oris scicitas subitanea, ac sitis vix poculo a 
labiis remoto recurrens, nec verbis describenda fu- 
erunt." 

Diarrhoea, principally of the serous kind, which is 
often excessive, is another among the profluvia which 
is accompanied by great thirst. 

The same may be said of ephidrosis, and more or 
less of all copious discharges of the animal humours, 
especially the aqueous ones. 

Besides the profluvia, other morbid states present 
thirst as a symptom to our consideration, and these 
are all those in which the animal machine has its or- 
ganic movements increased, in consequence of which 
some or other of the secretions or excretions are 
increased, or increase of heat is developed, which 
destroys a proportionate quantity of fluid material. 

Now from all these morbid states a fact may be de- 
duced, that in these there is produced a want of fluid 
or of aqueous matter. 

But we have seen before, that in all these conditions 
the animal receives the impression, more or less, of 



186 



an uncomfortable feeling called thirst, to remove 
which it seeks to introduce fluid into the body. 

Now as with this it is effectually removed, hence it 
follows as a consequence that thirst in animals is a 
certain condition of their machine caused in an un- 
known manner by want of fluid, and which is per- 
ceived by them as painful, and which feeling is in- 
tended to warn the individual of the want of fluid; 
whence meeting with it, it may restore the health (or 
integrity) of the machine. Hitherto, then, we have 
spoken of the final cause. 

Now if we would approach near to the discovery of 
the physical cause, we must shew in what it consists, 
from facts, and to what primitive system of organs 
that condition, undoubtedly material, appertains, 
which, when perceived by the mind, is called thirst. 
And to this knowledge it is not improbable we may 
arrive, but never can we hope to attain to the know- 
ledge of the means through which this condition is 
always the consequence of deficiency of fluid. The 
facts, moreover, in which it appears to us we may 
discover the material cause of thirst, reduce them- 
selves to one — the extreme activity of absorption 
which the inhalent extremities of vessels of the dif- 
ferent surfaces appear to acquire, when animals are in 
want of fluid, in consequence of profuse discharges, 
or from long abstinence from drink, and which state 
is expressed by the word thirst, demonstrated by the 
greediness with which fluid is sucked up by the lips 
and fauces in these morbid states, and which is also 
seen to occur over the whole surface of the body, par- 



187 



ticularly in profuse diarrhoeas, or in diabetes, to 
such a degree, that this disease was in fact attributed 
by some to the extraordinary cutaneous absorption of 
humidity from a damp state of the atmosphere. Also 
it is well known that in long voyages by sea, in case 
of want of water, the sailors try to quench the terrible 
sensation of thirst by covering the surface of their 
bodies with linen soaked in the sea. After this, 
who will say that we wander from the truth, main- 
taining that the material condition of thirst exists, in 
fact, in this organic and dynamic condition either of a 
part or the whole of the absorbent system ; that is, in 
increased activity respectively of the action of that 
part or whole. But some will argue that if thirst 
consists in this vascular condition which is the imme- 
diate consequence of want of fluid in the circulating 
system, how does it happen that patients are often 
manifestly in want of fluid, and yet do not complain 
of thirst. " lis," we answer with Hippocrates, " mens 
aegrotat." 

And in fact it is necessary on this point to reflect, 
and it may throw no small degree of light on different 
facts in the animal economy, both sane and morbid, 
that although the material condition of thirst just 
mentioned may be present, it is not necessarily a con- 
sequence that it should be perceived by the animal. 
How often on waking in the morning we feel sud- 
denly tormented by great thirst. Who can suppose 
that the material condition of this thirst begins imme- 
diately and at the very moment of waking ? No one 
in his senses. This existed undoubtedly during sleep, 
although the individual was not conscious of it. And 



188 



in this way there is no obstacle to affirming that thirst 
is an organic and dynamic condition, which not only 
all animals experience, but also all organized beings ; 
since an infinite variety of facts in the vegetable 
economy, both healthy and morbid, shews clearly that 
the individuals of this class suffer also, in similar 
cases, with animals, and most probably there exists 
in them a similar condition of a similar system. 

But to resume : if in all the above-mentioned morbid 
states which thirst accompanies, whether perceived 
or not, it is always the consequence of deficiency of 
fluid in the circulating system, why must not the 
same exist when dropsy accompanies it ? And cer- 
tainly, notwithstanding the many wonderful circum- 
stances which might induce a contrary opinion, dropsy 
is a disease, as the ancients considered, arising from 
superabundant " colluvies serosa." For how is it 
possible that so extensive a source of secretion and 
excretion, into which the immense membranous 
surfaces of the abdomen and of the thorax, (when 
dropsy arises there), are changed in consequence of 
inflammation, should not impoverish the circulating 
system ? 

But how does it happen, here we hear it objected, 
that if in dropsy there is thirst, and that the material 
condition of thirst is an activity of the lymphatic 
system, the disease does not disappear of itself ? And 
this happens in fact every time that it is not kept up 
by an actual inflammatory state of parts, or accom- 
panied by other organic alterations, and the lym- 
phatics have not suffered from the compression exer- 



189 



cised on them by the long stagnation of the fluid : 
and in fact, in practice, cases of dropsy separated from 
all these pathological conditions must be rare ; and 
also it is very natural to believe, that in dropsies of 
some standing, even though the inflammatory state of 
the parts in which they arose has disappeared, the 
absorbing extremities of the lymphatics of the parts 
must have lost their activity : hence the reason for 
the necessity, in the cure of dropsy, of bringing the 
lymphatic system into this state of thirst ; and if, in- 
deed, any of the divisions of that system, not exposed 
to one or other of the before-mentioned disabling 
causes, have suffered no alteration, in them it must be 
increased, in order that by extending it even to those 
lymphatics through which the absorption of the fluid 
morbidly collected ought to be effected, their inhalent 
power may be rendered more active. 

Now the primitive organic action of the increase in 
the activity of the absorbents, which we have dis- 
covered, in every case of want of fluid, to be the ma- 
terial condition of thirst, gives us in another manner 
the reason of the wasting, whatever may be the form 
of the disease which it accompanies, and hence of 
that wasting which accompanies dropsy. 

For by demonstrating that all the circumstances 
appertaining to this wasting (whatever may be the 
primary or secondary morbid process which it accom- 
panies) prove that its very existence supposes an 
impoverished state in the nutritious matter in the 
circulating system, and a defect in assimilation, and 



190 



the matter itself, which first rendered parts properly 
firm and nourished, certainly not vanishing, as we 
have proved in another place, except by increased ac- 
tivity in absorption, it is a consequence that this con- 
dition of this system of vessels exists in all cases of 
wasting; and that it is dependent on a hidden rela- 
tion between these vessels and the want of nutritious 
matter in the circulating system, analogous to what 
has been proved to exist between the same vessels and 
the want of fluid in the body. Every time, then, that 
the general circulating system, to which is owing 
the healthy action of organic life, is deficient in fluid 
matter, the lymphatics will take on that material con- 
dition, thirst, which might be said, in nearly the sense 
of Stahl, but really as a property of organized matter, 
to be, an appetite for fluid ; and every time that the 
same circulating system is in want of that substance 
from which it receives stimulus and materials for the 
entire preservation of the healthy actions of the animal 
machine, one or other of the divisions of the lymphatic 
system will take on a state of increased activity, pro- 
bably similar to the one already described, and which 
may, in a similar manner, be denominated appetite for 
nutriment. 

And who knows that this condition of the lym- 
phatics may not be one of the material conditions of 
hunger ? Nor, on the contrary, will it hold good to 
observe, that very often, where there is wasting, the 
patients do not complain of hunger, and eat little ; 
since we have seen that the material condition of 
thirst may exist, without the animal being aware of it. 



191 



We must here, however, warn our readers, that 
we are inclined to believe that there is a difference 
between that organic condition of beings, commonly 
called hunger, and the state of the lymphatics, which 
is the cause of the wasting in all cases in which the 
circulating system is in want of nutriment. Perhaps 
the greatest number of the causes which give rise to 
hunger exist in the stomach ; but we think it not 
improbable that one arises from the before-mentioned 
state of a part or the whole of the lymphatic system. 

But from among the facts which plainly demon- 
strate that the appetite, or hunger, of the whole 
system of the absorbents, or of some of its divisions, 
occasioned by the want in which the animal machine 
finds itself of nutriment, is the proximate cause of 
wasting, besides those before enumerated, the follow- 
ing places it beyond contradiction : — Those who catch 
marmots and dormice, assert that these animals are 
fat and welt nourished before they retire to their 
holes, and very thin and hungry when they wake from 
their long lethargy and quit their retreat. Now it is 
incontestible that these animals, even during their 
long sleep, must be in want of nourishment, because 
the organic functions are supported, however weak- 
ened they may have become. But they do not take 
in any nutriment from without, and must be supplied 
by that substance which envelopes parts in a greater 
quantity than is essential ; but this cannot be re- 
moved and transported into the great circulating 
system, except by means of the absorbents ; therefore 
an extraordinary activity in these vessels will be the 
sole proximate cause of the leanness of parts. 



192 



It is, moreover, the extraordinary activity in the 
absorbent system, which is the nearest proximate 
cause of the defect of either fluid or nutritious matter 
in the general circulating system : but there will be, 
between one and the other, links of a chain unknown 
to us — facts which bind them together more strictly ; 
since in truth we cannot yet see, between the one and 
the other, that necessary relation which ought to 
exist, before it can be maintained that one must be 
the effect of the other. Now, every time that, in phy- 
siological and pathological researches, we are in a 
similar difficulty, no little light is obtained from the 
investigation of final causes, very improperly de- 
spised and neglected by the modern observers of 
nature. 

It is precisely when we arrive at this point that 
we give the name of laws to these ultimate (for us 
primitive) facts. Hence, in the present instance, we 
consider it to be an established law or property of 
the lymphatic vessels in animals, and of those vessels 
which supply their place in vegetables, to increase the 
activity of their functions every time that the great cir- 
culating system, the generator and repairer of organic 
matter necessary to the harmonious performance of the 
circle of action, which constitutes life, is in want of ma- 
terials either aqueous or nutritious. 

Hence it is to this same law of the lymphatic 
system that is owing (besides the thirst) the wasting 
in dropsy, as in other diseases which it accompanies ; 
while we have also in the same, the more than suffi- 
cient cause of that which we have seen to be most 



193 



necessary for the production of the wasting — a defi- 
ciency of nourishment in the circulating system. 

Who does not see the largest source of the loss of 
nutritious matter, and the consequent impoverishment 
of the general system, in the profuse secretion and 
effusion of the fluid which constitutes dropsy, exuding 
from the extensive surface of the inflamed mem- 
branes? And in this sense most true is the idea, 
which the ancients, especially Aret£eus } distinctly en- 
tertained of the analogy between this disease and 
diabetes : for in truth there is, no less in dropsy than 
in diabetes, a morbid secretion and effusion of nutri- 
tious matter, demonstrating at the same time the re- 
semblance of some of the characteristic symptoms of 
the two diseases ; as the sweet taste, &c. And we have 
already shewn, that the excessive secretion called 
diabetes, like that of all the other humours, is no other 
than one of the symptoms of inflammation of the part 
from which it flows, or of another state less acute, 
which we have called " Nisus phologisticus." 



o 



104 



CHAPTER X. 



Explanation of the cure of Dropsy, derived from the 
reasoning in the preceding Chapter : reflections on 
that proposed by Cidlen, by Milman, by Danvin, by 
Rasori : and examination of the "modus operandi" 
of remedies to promote it. 



It is, above all, the law of the lymphatic system, de- 
clared in the preceding Chapter, which relates to its 
increased activity during a deficiency of aqueous or 
nutritious matter in the circulating system, (whilst at 
least its organization is entire), which, whilst it fur- 
nishes us with the most plausible explanation of many 
obscure points in pathology, regarding certain metas- 
tases, affords, above all, a satisfactory one of all the 
facts of the cure of dropsy, whether natural, or effected 
by medical aid. 

For having demonstrated that a dropsical patient 
is never cured without the excretion of some of the 
animal humours being rendered more active, either 
naturally or artificially — and having first demonstrated 
so many facts to prove that, under the same circum- 



19o 



stances, the lymphatic system acquires activity in its 
absorbent power, which, in the greatest number of 
cases, is perceived by the mind — at the same time 
the deduction is not more rigorous than that the dis- 
appearance of the aqueous collection constituting 
dropsy, not being able to be effected except by means 
of the absorbent vessels, is directly owing to the in- 
crease of their energy in proportion to the impover- 
ished state of the fluid in the circulating system, which 
proceeds from the copious secretion and evacuation 
of some animal humour, produced either naturally or 
artificially by means which increase secretion and 
excretion. 

And observe that this theory of the cure of dropsy, 
founded on our explanation of thirst, gives also a con- 
venient reason for the cure of this disease by the dry 
method, although the two would appear to be opposed 
to each other. For the greatest cause of the lym- 
phatic thirst, ought it not to be abstinence as much as 
possible from drink, and the promoting as much as 
possible cutaneous exhalation by sweat ? Hence is it 
not easy to comprehend the disappearance of the fluid 
morbidly collected, in every case in which its origin, 
inflammation, has been previously dissipated ? 

Hence, therefore, our theory of the cure of dropsy 
is not less unshaken and exclusive of all others, than 
that already established of its production, since it ex- 
plains all the facts which the history of medicine and 
daily experience shew to relate to it, while every other 
theory is repugnant to one or other series of facts, 
the truth of which the authors of such theories seek 



19G 



to deny. And in reference to those facts first related, 
regarding the cure of some dropsies by means of ex- 
ercise and abstinence from liquids, being of all others 
the most embarrassing to the theories of the causes 
and cure of dropsy usually proposed, these authors 
refuse flatly to admit them : as, among others, is the 
case with Milman and Darwin. 

But was it not doubtless from having seen the good 
effects, that Hippocrates advised the dropsical patient 
" edat sicca et acria, et quam minimum bibat, et quam 
plurimum laboret ?" and is it not of still more weight, 
since it is not deduced from, or brought forward in 
support of, any theory. Celsus says the same, when 
he expresses himself thus:— " Potio non ultra danda 
est, quam ut vitam sustineat;" to which he adds, that 
" multum ambulandum, currendum est," and still 
more, " evacuandus est sudor non exercitatione tan- 
tummodo sed etiam in arena calida." Galen, more- 
over, attests to have seen some dropsical patients 
who were cured by abstaining from drink for fifteen 
days : and passing over what Pliny writes of a certain 
Roman knight, Julius, who abstained through the 
decline of his life almost from drinking, and thus 
was cured of a dropsy, Bennivenius assures us that a 
countryman was cured of a dropsy by abstaining from 
drink during an entire year. 

But here it is necessary to observe, that we agree with 
Milman in discrediting this method of treatment, think- 
ing that it rarely can have a favourable result ; and the 
reason is this, — that in practice the cases of dropsy are 
rare in which the source of the inflammatory process 



197 



which produced them does not still exist; in which 
case not only is it necessary, as we shall see, to excite 
the lymphatic thirst, because it promotes the absorp- 
tion of the fluid already collected, but first of all it is 
necessary to deprive the dropsy of its source, by over- 
coming the inflammation which produces it. 

But it will be said, what novelty is there in this 
theory of the cure of dropsy, since Cullen has already 
stated, that the cure is to be obtained by the evacua- 
tion of the accumulated serum, by producing certain 
serous excretions, by which means the activity of the 
absorbents of the diseased parts may be excited ? But 
here we must observe, that though the author has 
stated the truth which we have been demonstrating, 
yet as it included a fact altogether hypothetical, be- 
cause hidden from our senses, it might with equal 
reason be denied. Nor, indeed, has Cullen shewn any 
more knowledge on the subject than was possessed 
by the ancients ; for they also well knew that the 
morbid collection of fluid diminished, and even disap- 
peared, by reason of abundant serous excretions : 
hence, imitating nature, they sought for the proper 
means to promote them, and the favourable result 
sanctioned, in all times, the powerful effects of eva- 
cuants in subduing dropsy. Thus Willis, in explaining 
the manner in which purgatives cure this disease, 
after having stated that a cathartic " arteriarum os- 
cula versus intestinorum cavitates dehiscentia irritat, 
ut per haec potius emissaria humor e sanguine re- 
jectus exitum inveniat," adds plainly, that " vasa in- 
anita aquam mox intercutim resorbent etpartim illico 
per sedem, partimque per urinas aut diaphoresi, 



198 



foras amandant." But what immediate and strict re- 
lation was there ever between the fact of the humoral 
evacuation, and the other assumed fact of the in- 
creased activity of the lymphatics of the internal ca- 
vities, that the last must be the immediate and neces- 
sary consequence of the first ? for the very principle 
of debility or atony of the general system, and parti- 
cularly of the lymphatics, maintained by Cullen as the 
principal cause of dropsy, through the defective con- 
dition of the absorbents, was incompatible w r ith the 
assumed action, since a deficiency in the power of the 
absorbents, through weakness or atony, ought to be- 
come increased in consequence of a debilitating cause, 
such as the evacuation of the animal fluids. 

We may repeat the same reflections on the expla- 
nation of the cure of dropsy left us by Milman, who 
says, <c earn in corpore animali obtinere legem, qua 
si medicamentorum ope magna aliqua evacuatio ex 
quavis parte provocetur, fit ut fluida quae aliis in par- 
tibus latent, resorpta, ad organa remediis sollicitata 
deferantur et eliminentur. Hinc humores hydro- 
picorum alibi in cavis hserentes ad intestina remediis 
purgantibus, vel ad renes diureticis devecti, foras pro- 
trudentur." But as these last ideas, in part similar to 
those of Willis, with the addition of the hypothesis of 
the retrograde motion of the lymphatics, form the 
whole of the attractive machinery of the theory of 
Darwin on the cure of dropsy, (although both Willis 
and Milman and Darwin set off from the erroneous 
supposition, that the fluids evacuated by purgative 
remedies employed in dropsies are the same as those 
morbidly collected in the different cavities constitut- 



199 



ing the disease), so the objections which we are about 
to bring forward against this last theory will be valid 
against the others. 

Darwin, after having maintained that the immediate 
cause of dropsy exists in the palsy of some of the 
branches of the absorbent system, called lymphatics, 
and which open upon the surfaces of the larger ca- 
vities of the body, and in the cells of the cellular struc- 
ture, in which a well-known fluid is secreted for the 
purpose of lubricating the surfaces, explains the cure 
of it, by means of drastics and purgatives, by sup- 
posing that these substances produce, on the internal 
surface of the alimentary canal, an inverse motion 
propagated to the lacteal and lymphatic vessels, by 
means of which, continued even to their open extre- 
mities in the different cavities, they promote in these 
vessels both a flow of lymph contrary to the natural 
direction, and at the same time an increased activity 
in the absorbent action of their extremities. Now, in 
this theory, the celebrated Darwin has advanced no- 
thing new except an hypothesis contrary to the expe- 
riments and established observations of anatomists, 
which is, that the lymphatics invert their action, in 
order to explain the transport of the fluid of dropsy 
from the part in which it was collected to the intes • 
tines ; a fact already awkwardly assumed by Milman, 
and pretty clearly stated by him. 

Now, omitting all the valid anatomical and physio- 
logical reasons of Professor Jacopi, against this imagi- 
nary transport of fluid without its passing through 
the circulation, and his own reasons, still more deci- 



200 



sive, against the possibility of the lymphatics taking 
on the desired inverse action— and omitting no less 
our own opinions mentioned in the first part of this 
work, in opposition to all the laws of the excitability 
of Darwin, and particularly of that torpor, which, in 
this place, he makes the principal cause of his imagi- 
nary condition of the lacteals and other lymphatics — 
we must observe, that in order to maintain that the 
fluid evacuated from the intestines, in dropsy, by 
means of drastic purgatives, proceeds immediately 
from the cavities where it was morbidly collected, it 
will be necessary to prove, first, the identity of the 
principles composing it ; secondly, to shew that the 
same medicines, if administered in a state of health, 
or in any case in which a morbid collection of fluid 
does not exist, do not produce the same evacuations 
from the intestines — which is precisely contrary to the 
• fact. 

But in reference to these hypotheses ; first, the 
torpor of the extremities of the lymphatics excited by 
these remedies : secondly, the retrograde motion in 
these vessels, consequent on their application, the most 
singular and strange action, and the reality of which 
must be most necessary to the theory ; and lastly, 
the third, which is put forth as a consequence of the 
other two, viz. the increased activity in the mouths of 
the absorbents, which open in the different cavities 
where the morbid collection of fluid is found. 

And in truth, if by laying aside the anatomy of the 
structure of the lymphatics, and the experiments re- 
lative to it, we could conceive an inverse movement 



201 



in them possible, it would be a mutter of indifference 
to concede its existence : but it must be impossible 
for any one in his senses to believe how such a motion 
can increase absorption ; and being changed into an 
opposite one, not only is the action not disturbed, but 
even rendered more active and increased in force. 
Hence something more is wanted than mere dreams, 
in order to make us renounce the common opinion, 
supported by all the facts relative to the different hu- 
moral secretions, rather than the idea that the evacu- 
ations from the intestines, under the administration of 
drastic purgatives, are merely the effect of activity in 
the secreting action of organs produced by these sub- 
stances, and precisely similar to the increase of the 
saliva or of tears, after the application of acrid sub- 
stances to the mouth or the eye. 

But coming to the great Italian, the translator of 
Darwin, the celebrated Rasori, we must observe, that 
in his note to the 200th page of the Zoonomia, having 
shewn that he believes with Darwin that the urinary 
and intestinal evacuation in dropsies treated with the 
digitalis, with drastics and emetics, depend on the re- 
trograde action of the lymphatics, in that to the 224th 
page of the same volume, he is opposed to this 
theory, saying, that drastics and emetics do not cure 
the dropsy by producing increased absorbent action 
in the lymphatics of one part or another, but by de- 
stroying the sthenic diathesis of which the disease is 
constituted, the evacuation of the fluid being a second- 
ary action. 

Now in these two notes, if it is not wished to blame 



202 



the author for a manifest contradiction, it becomes ne- 
cessary to infer that he maintained dropsies to be 
cured by these remedies by the removal of the sthenic 
diathesis ; and besides this, by bringing in the retro- 
grade motion of the lymphatics, through which the 
evacuation of the water follows, without its passing 
through the circulating system. And here we must 
remember, that one of Rasori's first disciples, to 
whom, as our master, we owe the most distinguished 
respect and gratitude, teaching that drastics act by 
contra- stimulus, and recommending them in dropsies 
termed sthenic, explained the cure not only by an 
imaginary primitive vital action, but in addition, he 
attributed the evacuations following their administra- 
tion to the retrograde action of the lymphatics in- 
duced by them. Thus, (returning to Rasori) the 
evacuation of the water in dropsy treated by drastic 
purgatives, is, in his opinion, a secondary effect ; that 
is, to the destruction of the sthenic diathesis which 
obstructed absorption, and also to the retrograde 
movement induced by them. 

Now to say that these remedies destroy the sthenic 
diathesis of the lymphatic system, is the same as to 
say that they restore it to a natural condition ; hence 
this inverse movement will be a natural and healthy 
condition. 

Who among the partizans of the contra-stimulant 
doctrine, being convinced by the incontrovertible ar- 
guments taken from anatomy, physiology, pathology, 
and logic, must have rejected this imaginary condi- 
tion of the lymphatics, how can any one of these ex- 



203 



plain that, by the simple removal of that sthenic dia- 
thesis of the whole body, which we have demonstrated 
to be hypothetical, and otherwise repugnant to the 
truth, the before-mentioned remedies can bring on 
the sudden and often surprising cure of dropsy, which 
not unfrequently we have seen to be the effect of their 
administration ? In fact, if these substances, by means 
of the removal of the sthenic diathesis, restore the ab- 
sorbent vessels to their healthy condition, who shall 
say that, merely in consequence of this restored na- 
tural absorption, the entire subsidence of an ascites, 
which is seen to succeed in one night to abundant in- 
testinal evacuation, consequent on the administration 
of some drastic medicine, takes place ? Besides, if by 
the simple removal of the sthenic diathesis of the 
body and of the lymphatics, these remedies cure 
dropsy, why has no cure ever been obtained, or, as 
we maintain, ever will be obtained, with the true 
contra-stimulant remedies, such as the lauro-cerasus, 
the belladonna, &c. ? 

But before terminating this discussion, we cannot 
do otherwise than make some observations on the 
opinions on which Signor Rasori prides himself, at 
page 176 of the third edition of his excellent work on 
the Petechial Fever of Genoa. He says, " that his 
treatment of sthenic dropsies, (when he was professor 
of pathology, and physician to the Hospital of Pavia), 
was not conducted with pretended specifics— the lan- 
guage of quackery or ignorance, and the cause of 
grievous errors in practice — but with those very re- 
medies, freely employed, which are adapted to any 
other sthenic disease ; purgatives of every kind, 
whether mild or drastic, tartar emetic, nitre, abundant 



204 



drink, and low diet." Then the cure was not with spe- 
cifics, but always withevacuants. Behold the real spe- 
cifics for dropsy ! If he wished to prove that, in the 
cure of these dropsical patients the only question was to 
overcome the sthenic diathesis — by which, according 
to him, the disease is kept up, and that the effect of 
these evacuants could depend solely on their anti- 
sthenic or contra-stimulant action — he ought to be able 
to shew cures of dropsical patients with the true con- 
tra-stimulants alone, such as the lauro-cerasus, bella- 
donna, hyoscyamus, &c : not being able certainly to 
assert that they have employed the former remedies 
in preference to the latter ; because their contra-sti- 
mulant action is directed specially to the lymphatic 
system, which would be not only a gratuitous and hy- 
pothetical assertion, but contradicted, moreover, by 
their effects, always the same, as we have observed in 
every state of health and of disease. And here it may 
be permitted us to deny absolutely the other merely 
systematic proposition, that we sometimes see opiates, 
aether, and bark, operate as diuretics ; — a proposition 
put forth gratuitously in this place, in order to deny 
the diuretic property of those substances which the 
observation of all times has sanctioned, and of which 
any one may satisfy themselves by taking them in a 
state of health. 

It is, therefore, for all these reasons, that we main- 
tain the humoral evacuation, produced by emetico- 
cathartic remedies, to arise from the physical action 
exercised by these substances irritating the struc- 
tures of the intestine destined for secretion j and that 
these, in consequence of the organic laws of irrita- 
tion, laid down in the first part of this work, having 



205 



their action increased, caused the increased evacu- 
ation or secretion to follow. 

Nor certainly do the cures of dysentery by Dr. 
Pisani, effected by jalap alone, or combined with 
neutral salts, or those of his master, Signor Rasori, 
by gamboge, present any insuperable difficulty to 
this view. In the same proportion that the dejections 
were diminished in number, but increased as to 
quantity, the malady was cured, for the matter was 
thrown out which had occasioned the dysentery in 
the interior of the intestines. 

Now what we have advanced in reference to 
drastics may be extended to diuretic and diaphoretic 
medicines, while from these we select the digitalis, 
which we are much inclined with Professor Fanzago 
to distinguish as possessing two modes of action — one 
of irritation, and the other of contra- stimulus ; but in 
this sense, that this plant, like all other poisonous 
plants, possesses, besides, the principles which exer- 
cise an irritating property, producing pain when 
in contact with various animal structures ; one 
more hostile to life — contra- stimulus. Hence the 
first is that which, being unable to be assimilated, 
passes with the blood into the organs secreting 
the urine, and augments their secreting functions, 
from whence arises (in a sense entirely organic) 
a painful and irritating effect, whilst the contra- 
stimulant principle which it possesses will in- 
fluence greatly the cure every time the dropsy shall 
have been kept up by a real inflammatory condition ; 
but when this shall have entirely vanished, or only 



206 



exists with its product, dropsy, an enfeebling of the 
whole system of organic actions : even while it pro- 
motes humoral evacuations, it will produce a bad, a 
most evil effect, with its contra-stimulant property 
rendering the vital actions still more weak and lan- 
guid. Hence the mixture of spirit with the digitalis, 
used by the English, is most reasonable : and, in truth, 
the good effect of this mixture in cases of dropsy, as 
employed by them, and its diuretic properties con- 
tinuing unaltered, ought to be more than sufficient 
to prove that the power of digitalis in promoting the 
evacuation of urine arises from a very different cause 
than its contra-stimulant action. 

And in reference to these principles, which cannot 
be assimilated by the circulating system, we do not, 
in truth, see sufficient reason to marvel so greatly as 
Dr. Morechini does, in order to determine us to be- 
lieve that every kind of urine is not always separated 
from the blood, but that it may succeed to a direct 
transference of different substances from the chylo- 
poietic to the uripoietic viscera, independent of the 
sanguiferous system. Nor can the results of the ex- 
periments of Darwin or Rasori move us, which would 
appear to demonstrate, that no traces were found in 
the blood of some substances introduced into the 
stomach, while they were manifested in the urine. 

Might not these elements be separated in the blood, 
and recombined with others which no longer present to 
our senses the usual signs of their presence, and even 
elude chemical reactives, but become recomposed 
in the secreting apparatus of the different animal 



207 



fluids. It may be added also, that we are inclined to 
believe with MM. Henry and Pearson, that if these 
substances are really discoverable in the blood, they 
should be sought for in the arteries, and not in the 
veins. 

But if in these substances with which dropsy is 
cured we must not maintain any virtue to exist ex- 
cept the sensible quality of promoting this or that 
humoral secretion or evacuation, how will the pa- 
thologists explain, under their employment, the dis- 
appearance of the fluid morbidly collected in the dif- 
ferent cavities which constitutes dropsy ? and, in truth, 
for any one, not so foolishly ready to attribute hypo- 
thetical properties to these or those substances, nor to 
describe certain conditions of organs never demon- 
strated to exist by physiological or pathological ana- 
tomy, the cure of dropsy, by the use of remedies 
which the observation of all time has proved to be 
most efficacious, was certainly still problematical. 
Thus no one hitherto has answered the difficulties 
proposed by Rasori, against the cure of dropsy by 
substances possessing the power of increasing the 
secretion of urine. He thus expresses himself: — 
" Whatever may be the kind of dropsy, the fluid 
which constitutes it is extravasated in a cavity, that 
is to say, out of the circulation, while, on the con- 
trary, the supposed diuretic action is exercised on 
the kidneys, which is to say, within the course of the 
circulation. This being the case, the diuretic might 
produce a diabetes, by the increased quantity of 
urine which the kidneys might separate from the 
blood in less time than ordinarily ; but this action has 



208 



nothing ro do with the extravasated lymph, which is 
beyond the action of the kidneys, and removed from 
the mass of the blood." Which first reflection might 
be understood as being just when extended to the 
action of em eto- cathartic remedies. 

But the cure of dropsy is still a secret to the most 
moderate and reasonable among the contra-stimu - 
lists, who maintain that these substances are indirect 
contra-stimulants, while, besides it not being easy, 
as we have already seen, to comprehend how with 
the single removal by their action (which is a debi- 
litating one), of the imaginary sthenic state of the ab- 
sorbents, certain sudden cures of dropsy ensue. It is, 
moreover, absolutely impossible to explain how the 
same substances are necessary to the cure even of 
those dropsies in which the general circle of action is 
decidedly enfeebled and languid, and which they call 
asthenic, and in which it becomes necessary to ad- 
minister them at the same time with stimulant re- 
medies. 

And from this fact it would have been equally im- 
possible for us to understand the cure of dropsy, if 
we had not proved that organic law of the lymphatic 
system which respects increased activity of the ab- 
sorbent system, when there is a deficiency of fluid 
occasioned by the great loss of the animal humours. 
In the meantime, having demonstrated by facts that 
dropsy is merely a product of inflammation, we may 
well comprehend how it could be overcome, and its 
source removed, by these evacuating, and hence de- 
bilitating, substances, but never how the disappear- 



209 



ance of the fluid would succeed, and still less how 
they must be necessary for the cure of dropsy, not 
only when inflammation no longer exists, but there 
is a decided enfeeblement of vital action, and in 
which the practice of all physicians has shewn it to 
be necessary to administer stimulants. But it was by 
the proposed law of organic life, that through the 
humoral discharges, promoted by these evacuating 
substances, inducing necessarily in the circulating 
system a relative defect of fluid, the lymphatics must 
take on a state of thirst, or an increased activity in their 
absorbing power, that we have understood easily 
all the facts relating to the cure of dropsy, and have 
been able to establish, on this important pathological 
question, a theory which partakes in no way of the 
nature of an hypothesis. 



v 



210 



CHAPTER XI. 

The indications of the cure of Dropsij, derived from 
the opinions lately explained. 



The curative indications of dropsy cannot be reduced 
to fewer than these two general ones : — 

1. To destroy the source of the morbid collection 
of fluid. 

2. To evacuate the existing collection of fluid. 

And these, in truth, were always reputed as indica- 
tions, by all physicians ; but inasmuch as no one, up 
to this time, has displayed or established irrefragably 
the true source of dropsy, through all the facts ap- 
pertaining to the disease, hence in the discrepancy 
which existed in the theories invented in reference to 
it, in the different schools, the curative method an- 
swering to this first indication must necessarily have 
been erroneous and uncertain. And even in refer- 
ence to that method of the physicians, most attached 
to, and most uniform in following their preconceived 



211 



ideas, a method which appeared to the greater num- 
ber, supported by facts, viz. the stimulating one — that 
is, precisely the one opposed to what is called for to 
subdue the pathological process which constitutes 
the source of dropsy — it is not to be wondered at that, 
in following such a course, they should have been 
little fortunate in the cure of the disease; more espe- 
cially the physicians at the conclusion of the eighteenth 
century, who were not permitted by the laws of ex- 
citability to adopt at the same time evacuants, except 
when, by good fortune for their patients, they de- 
ceived themselves in their judgment of the vital action 
of the latter medicines. 

But we have with sufficient reason established — be- 
sides having demonstrated that dropsy is a morbid 
collection of fluid of new formation, or consisting of 
a morbid secretion formed by the surfaces of the parts 
where it is found — that the pathological condition 
taken on by these surfaces, which enables them to 
produce the disease, is no other than inflammation. 
This, we say, we have proved from the four following 
facts : — 

1 . That the dropsical fluid differs from that which 
naturally exhales from the cavities of the body. 

2. That it is exactly similar to what is visibly pro- 
duced by inflammation. 

3. That it is found only with organic alterations, 
undoubtedly the product of inflammation. 



212 



4, That all physicians have seen dropsy succeed 
to diseases maintained by them to be decidedly inflam- 
matory. 

Now, investigating the facts contained in the works 
of the greatest observers, taken from the daily prac- 
tice of ail physicians, relative to the method of cure 
in dropsies — in the examination of which we have 
seen that every cure of this disease has always been 
obtained by one or other of these two methods, viz. 
either by the employment of substances capable of in- 
creasing one or other of the humoral discharges, 
either alone or in combination with others which en- 
feeble organic movements ; or by administering with 
these evacuants substances capable of exciting actions 
and functions which maintain the necessary nutrition 
of parts, (with which facts we have demonstrated the 
theory of diathesis, in the production, and the cura- 
tive induction drawn from it, to be inconsistent) — 
we may plainly maintain that every case of dropsy 
which presents itself in practice will certainly be one 
of the following three: — 

1. Either the dropsy accompanies, and hence is 
kept up by inflammation of the parts in which it is 
found ; — 

2. Or the inflammatory process may have already 
disappeared, either naturally or by the use of medi- 
cine, and the general circle of vital actions may be in 
a state nearly natural; but because the absorbing 
power of the lymphatics may have suffered by the 



213 



long compression made by the fluid, and because the 
natural action of the absorbents is not sufficient for its 
removal, it is necessary to increase and render more 
active this absorbing power ; — 

3. Or not only may the inflammatory state have 
ceased, but, besides, the organic actions of the animal 
machine may have become enfeebled and languid, 
either because the presence of the fluid morbidly col- 
lected may disturb the proper performance of chyli- 
fication, sanguification, and consequent nutrition, or 
perhaps, unhappily, organic alterations exist in one 
or other of the viscera, from the preceding inflam- 
mation, which prevent the regular exercise of their 
functions, on which the well-being of the animal 
depends. 

Every one will see, that in all cases of dropsy the 
original cause of the morbid collection is not always 
subsisting, but cases may be seen in which it is al- 
ready overcome. It will be, therefore, of the first 
importance to the happy conclusion of the treatment, 
to discover first, in every case of dropsy which pre- 
sents itself, whether the cause which we have marked 
out exists or not ; and in case it does not, if the ge- 
neral system be in a tolerably healthy state, or lan- 
guid and enfeebled : hence one of the curative indica- 
tions, that of getting rid of the morbid collection of 
fluid, is, as we have seen, common to all cases of 
dropsy. 

Considering, then, the first indication, we may fear- 



214 



lessly maintain, that it can alone occupy us in the cases 
in which the inflammation still exists, which keeps 
up and increases the morbid collection of fluid : but 
besides attending to the first, it is also necessary at 
the same time to fulfil the second indication. Now 
the means which carry this into effect, are, as all 
know, the evacuation of blood, and the administration 
of those substances which enfeeble directly the im- 
pulses of organic action, and inflammation, which is 
the increase of these, contra-stimulants, properly so 
called, and also of other medicines which produce the 
same effect, by promoting the evacuation of the animal 
fluid. 

In reference to these last substances it will be well 
to remember also, that whilst they appeal' to be the 
most proper to subdue dropsy, and hence were always 
most commonly used, inasmuch as they fulfilled both 
indications, viz. the destruction of the source of the 
morbid collection of fluid, and also the expulsion of it, 
through the medium of the evacuation caused by their 
action, and the consequent increase in the activity of 
the absorbents, in consequence of the impoverished 
condition of the fluid in the circulating system. 

And on this subject it will be necessary to observe, 
that these substances are of themselves sufficient to 
effect alone the cure of dropsy, not only in the cases in 
which the inflammatory process actually existing, 
and which keeps up the complaint, is very slight, but 
also to destroy or remove the feebleness of organic 
action consequent on the evacuation of fluid. 



215 



Every time, on the contrary, that the inflammation 
no longer exists, the necessity for using the means ne- 
cessary to overcome it must cease, and we must avoid 
both bleedings and contra-stimulant remedies ; but the 
indication being the same, to disperse the fluid already 
collected, we must look to those remedies which ex- 
perience has demonstrated to be the most powerful for 
this purpose. 

Now these we shall see to be all those substances 
which promote the evacuation of the serous fluid : 
but the evacuation of these animal fluids is shewn by 
experience (we beg pardon of those who consider 
them to be contra-stimulants) to induce an enfeebled 
state of the organic functions. Being obliged ne- 
cessarily to run the risk, by removing, even with 
these remedies, the morbid collection of fluid, of 
suffering the patient to perish through inanition 
or real weakness, it will be our aim to administer 
also substances demonstrated by experience to be 
capable of increasing vital power, and of maintaining 
the necessary nutrition of parts. 

It being conceded that the inflammation no longer 
exists which produced the dropsy, but there is really 
only present the languid condition of the vital forces, 
any one may see, in this case, how much the necessity 
is increased of administering the substances before 
mentioned, at the same time with those which sti- 
mulate the absorbents, that is, evacuants — which, as 
we have seen, are always necessary to the cure of 
dropsy. 



21G 



And here it may be observed, that with our doctrine 
we may finally cut the knot of the controversy among 
physicians, as to the advantage or non-advantage of 
the paracentesis in ascites. 

For if the morbid collection of fluid be enormous 
and of long standing, will it not be obvious to 
think that the absorbents would suffer, as has 
already been mentioned, by the pressure of fluid 
against membranous surfaces ? and hence will it not 
be a good practice, taking away the pressure by the 
immediate evacuation of the water, to induce the de- 
sired active state of the lymphatics by remedies ? But 
that which on this subject it will be equally impor- 
tant to determine in practice, is, whether an inflam- 
matory condition of the membranous surfaces be ac- 
tually existing or not. 

Now the presence of this condition, even in ascites 
of long standing, is in truth much more frequent than 
has been commonly believed by physicians ; and we 
incline to attribute principally to this state the rare 
occurrence of the radical cure of ascites by paracen- 
tesis, (to a degree, that some even reject its employ- 
ment as useless), because after the operation blood- 
letting is ' no longer thought of. We shall not, 
however, be far from the truth, if we lay it down as a 
rule that tapping is not, in general, desirable in an 
actually inflamed condition of the membranous sur- 
faces ; and if it is wished to adopt it, we ought not af- 
terwards to desist from blood-letting, (in proportion 
to the severity of the inflammation which continues), 



217 



at the same time using evacuating remedies and real 
contra-stimulant medicines. When, however, we dis- 
cover, that without doubt the inflammatory process 
which produced the ascites is overcome, then the ope- 
ration of tapping will be more than desirable, and 
still more so in the case in which the general system 
is in a sensible state of feebleness. 

But to our theory of the cure of dropsy, not less 
than to its cause, which appears to us to embrace all 
sorts of cases appertaining to this disease, we are 
persuaded that some one will think it right to oppose 
a grave objection in the radical cure of hydrocele 
obtained by incision, and the injection of some 
stimulant fluid. How, in fact, will he say, can we 
recognize the origin of the fluid of a hydrocele from 
an inflammatory state, if the means employed, with 
the happiest success, are, in fact, to produce an in- 
flammation in the same structure ? In fact, every 
one has, in the opinions already delivered, sufficient 
materials to overcome such imposing difficulties with 
facility. 

In Chapters II., III., and IV. 3 we have shewn that 
it is a given degree of inflammation, and no other, 
which generates the fluid in which dropsy exists. 
Hence, where is the wonder, that by changing by art 
the inflammatory condition of the tunica vaginalis, 
which produces dropsy, into that which pours out 
coagulable lymph, the means are taken away from 
the membrane of pouring out water, and even the 
cavity obliterated which contained the fluid ? 

Q. 



2 1 8 

Hence, therefore, all other dropsies, whatever be 
the part in which they are found, must recognize 
the universal cause (inflammation), hitherto irre- 
fragably demonstrated as their origin. 



THE RND. 



Wilso.v ic Sox, Printers, 57, Skinner-Street, Lo;idou. 



\1 M 



London, September 1836. 

VALUABLE STANDARD WORKS, 



MEDICINE, 
SURGERY, 



MIDWIFERY, 
CHEMISTRY, &c. 



PRINTED FOR 

LONGMAN, REES, ORME, BROWN, GREEN, and LONGMAN, 



A TREATISE ON OPERATIVE SURGERY. 

By W. P. COCKS, Surgeon, 
Author of "Illustrations of Mr. Samuel Cooper's Surgical Dictionary," comprised 
in above 400 Plates, with Anatomical Descriptions. 

1 vol. 8vo. illustrated by Twelve Plates.— In the Press. 

*** This Work will be a Comprehensive Manual of Practical Surgery, embracing illus- 
trated details of all the Operations, Major and Minor, as they are performed on the Living 
and Dead Subjects by the most eminent Surgeons in this country, on the European 
Continent, and in America. 



ELEMENTS OF MEDICAL JURISPRUDENCE. 

By T. R. BECK, M.D. 

Professor of the Institutes of Medicine,and Lecturer on Medical Jurisprudence, in the College 
of Physicians and Surgeons of the Western District of the State of New York, &c. ; and 

J. B. BECK, M.D. 

Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and 
Surgeons, New York, one of the Physicians to the New York Hospital, &c. &c. 

8vo. 5th Edition, brought down to the present time, including the Notes 
of Dr. Dunlop and Dr. Darwall. 21s. 

" Berk's Medical Jurisprudence, in its present enlarged form, has been rendered quite an Encyclo- 
paedia on the subject : it is an admirable book of reference, and ought to be in the hands of every member 
of the profession."— Med. Gaz. March 19, 1836. 



FIRST LINES OF THE PRACTICE OF SURGERY; 

Explaining and illustrating the Doctrines relative to the Principles, Practice, and 
Operations of Surgery, as taught 

By SAMUEL COOPER, 

Surgeon to the North London Hospital, Professor of Surgery and Clinical Surgery in 
the University of London, &c. 

By the same Author, 

Dictionary of Practical Surgery. 1 thick vol. 8fo. 28s. 

Illustrations of Ditto, in above 400 Plates, with Anatomical Descriptions. 
By W. P. Cocks, Surgeon. 
2 vols. 8vo.- Vol. 1.21. 2s.; Vol. 11.31. 7s. 6d. 



2 



VALUABLE WORKS ON MEDICINE, SURGERY, ETC. 



Mr. Abernethy. 



SURGICAL AND PHYSIOLOGICAL WORKS 

OF 

JOHN ABERNETHY, F.R.S. &c. 

4 Vols. 8vo. 21. 5s. 6d. Consisting of the following Treatises and Lectures, 
which may also be had separately : — 



I. — On the Constitutional Origin 
and Treatment of Local Diseases, 
and on Aneurisms, 8s. 

II. — On Diseases resembling Syphilis, 
and on Diseases of the Urethra, 65. 



III. — On Injuries of the H ea u, and Mis- 

celi.aneous Subjects, 7s. 

IV. — On Lumbar Abscesses and Tu- 
mors, 6.9. 

V. — Lectures on Surgery, 8s. 



VI.— Physiological Lectures, 10s. 6d. 



Dr. Ainslie. 

MATERIA INDICA; 

Or, some Account of those Articles which are employed by the Hindoos, and other 
Eastern Nations, in their Medicine, Arts, &c. 

By Whitelaw Ainslie, M.D. M.R.A.S. In 2 vols. 8vo. 21. 



Dr. Aldis. 

INTRODUCTION TO HOSPITAL PRACTICE, 

In various Complaints; being a Clinical Report of Fever, Gont, Rheumatism, Cholera, &c. &c; 
with Remarks on their Pathology and Treatment. 

By C.J. E. Aldis, M.A. M.B. and L.M. 1 vol. 8vo. 5s. 



Dr. Arnott. 

ELEMENTS of PHYSICS, 
Or Natural Philosopliy, General and Medical, written in plain or non-technical language. 
By Neil Arnott, M.D. 
8vo. many Wood Engravings, 5th edit. Vol. I. 21s. and Vol. II. Part I. 10s. 6d. 
The concluding Part of Vol. II. of the work is in progress. 



Dr. Abercrombie. 

PATHOLOGICAL AND PRACTICAL 
RESEARCHES on DISEASES of the BRAIN and SPINAL CORD. 
By John Abercrombi e, M.D. Oxon. and Ediu. V.P.R.S.E. &c. &c. 
12mo. 3d Edit, greatly enlarged, 5s. 6d. 



Dr. Addison §• Mr. Morgan. 

AN ESSAY ON THE 
OPERATION of POISONOUS AGENTS upon the LIVING BODY. 
By John Morgan, F.L.S. Surgeon to Guy's Hospital ; and 
Thomas Addison, M.D. Assistant Physician to Guy's Hospital. 
8vo. 5s. 



Mr. Bacot. 

TREATISE on SYPHILIS, 
In which the History, Symptoms, and Method of Treating every Form of that Disease, 
are fully considered. 

By John Bacot, Surgeon to the St. George's and St. James's Dispensary, &c. 8vo. 9« 



PRINTED FOR LONGMAN, REES, AND CO. 



3 



Dr. Baillie. 

MORBID ANATOMY 

Of some of the most important Parts of the Human Body. 
By Matthew Baillie, M.D. 

With Observations on Diseased Structures, by James Wardrop, Surgeon to the King. 

12mo. 7*. 

Life and Works of Dr. Baillie. 2 vols. 8vo. with Portrait, 1/. 5s. 



Mr. Balbirnie. 

THE SPECULUM applied to the DIAGNOSIS and TREATMENT of 
the ORGANIC DISEASES of the WOMB : 

An Inaugural Dissertation, presented to the University of Glasgow, 
for the Degree of Doctor in Medicine. 
By John Balbirnie, A.M. 8vo. 12s. bds. 



Dr. Bat eman. 

PRACTICAL SYNOPSIS of CUTANEOUS DISEASES, 
According to the Arrangement of Dr. Willan ; 
Exhibiting a concise View of the Diagnostic Symptoms, and the Method of Treatment. 

By T. Bateman, M. D. Seventh Edition, edited by A. Todd Thomson, M. D. F. L. S. 
Professor of Materia Medica in the University of London. 8vo. 15s. 

Delineations of the Cutaneous Diseases comprised in the Classification of the 
late Dr. Willan. By T. Bateman, M.D. &c. 4to. with 72 coloured Plates, 12/. Vis. 

Atlas of Delineations of Cutaneous Eruptions ; illustrative of the Descrip- 
tions in the above Synopsis. By A. Todd Thomson, M.D. &c. Royal 8vo. with 29 col'd 
Plates, 2,1. 3s. 

Sir George Balling all. 

OUTLINES of the COURSE of LECTURES on MILITARY SURGERY, 

Delivered in the University of Edinburgh. 
By Sir Geo. Ballingall, M.D. F.R.S.E. &c. &c. 8vo. 18s. 



Sir Charles Bell. 

ANATOMY and PHYSIOLOGY of the HUMAN BODY. 
By John and Charles Bell. 
7th Edition, systematized by Sir C. Bell. 
, 3 Vols. 8vo. numerous Engravings, 2/. 12s. Qd. 

Engravings of the Arteries; illustrative of the above Work. 
By Sir C. Bell. Imperial 8vo. 15s. ; coloured, 1/. Is. 

By the same Author, 

Illustrations of the Great Operations of Surgery : 
Trepan— Hernia — Amputation — Aneurism — Lithotomy. 
4to. with 20 Plates, 3/. 15s. plain ; 51. 5s. col'd. The Parts separately ,1b s. plain ; 21s. col'd. 

Nervous System of the Human Body. 
4to. with Plates, 1/. 16s. 

Diseases of the Urethra, Prostate, Rectum, &c. 
8vo. 13s. 6d. 

Engravings from Specimens of Morbid Parts, in the Author's Collection; 
Selected from the divisions Urethra — Vesica — Ren— Morbosa — Laesa, &c. 
Folio, 36s. 



4 



VALUABLE WORKS ON MEDICINE, SURGERY, ETC. 



Mr. G. H. Bell. 

TREATISE on CHOLERA ASPHYXIA, or EPIDEMIC CHOLERA, 

As it appeared in Asia, and more recently in Europe ; &c. 
By G. H. Bell,F.R.C.S.E. &c. 2d Edit. 6s. 
By the same Author, 
Treatise on the Diseases of the Liver, and on Bilious Complaints. 6s. 

Dr. Bennett. 
MANUAL of ANATOMY; 

From the French of Bayle. 
Revised and improved by W. Bennett, M.D. I8mo. 7s. &d. 

Dr. BJackall. 

OBSERVATIONS on the NATURE and CURE of DROPSIES. 
By John Blackall, M.D. Svo. 4th Edit. 10s. 6d. 

Dr. Bright. 

REPORTS of MEDICAL CASES; 

Selected with a view of illustrating the Symptoms and Cure of Diseases by a reference 
to Morbid Anatomy. 

By Richard Bright, M.D. F.R.S. one of the Physicians to Guy's Hospital. 4to. 

Vol. I. embraces Dropsy, Inflammation of the Lnngs, Phthisis, and Fever ; with 16 coloured 
Plates, 41. 4 s. 

Vol. II. contains Diseases of the Brain and Nervous System; with 38 Plates, 9/. 9s.col'd. 

Drs. Bright 8f Addison. 

ELEMENTS of the PRACTICE of PHYSIC. 
By Richard Bright, M.D. F.R.S. , audTHOMAs Addison, M.D., Lecturers on the 
Practice of Physic at Guy's Hospital. 
In 8vo. 

V* The First Fasciculus will embrace the subject of Fever. 



Dr. Burne. 

PRACTICAL TREATISE on the TYPHUS or ADYNAMIC FEVER. 
By J. Burne, M.D.&c. 
8vo. 7s. Qd. 

Sir B. C. Brodie, Bart. 

LECTURES on the DISEASES of the URINARY ORGANS. 
By SirB. C. Brodie, Bart. V.P.R.S. 
Second Edition, with alterations and additions. 8vo. 8s. 
By the same Author, 
Pathological and Surgical Observations on Diseases of the Joints. 
8vo. 3d Edition, revised, altered, and enlarged. 10s. 6d. 

Professor Burns. 

PRINCIPLES of MIDWIFERY ; 

Including the Diseases of Women and Children. 
By John Burns, M.D. Regius Professor of Surgery, Glasgow. 
Svo. 8th Edit, with important Additions, 16s. 
By the same Author^ 
Principles of Surgery, 
Vol. I. containing Inflammation, Tumors, Aneurisms, &c. Svo. 14s. 



PRINTED FOR LONGMAN, REES_, AND CO. 



5 



Dr. Carbutt. 

CLINICAL LECTURES, delivered in the MANCHESTER INFIRMARY. 
By Edward Carbutt, M.D. 12*. 



Mr. Carmichael. 

ESSAY on VENEREAL DISEASES, 
AND THE USES OF MERCURY IN THEIR TREATMENT. 
With Drawings of the forms of Venereal Eruptions. 
By Richard Carmichael, M. R. I. A. 2d Edition, 8vo. 16*. 



Dr. Car swell. 

ILLUSTRATIONS of the ELEMENTARY FORMS of DISEASE. 

Imperial 4to. with eol'd Figures of the natural size, and Descriptive Letter-press. 
By R. Cars well, M.D. Prof, of Path. Anat. London University. 
Fas. I. Tubercle ; Fas. II. and Fas. III. Carcinoma ; Fas. IV. Melanoma ; 
Fas. Y. Softening ; Fas. VI. Hemorrhage ; Fas. VII. Mortification ; 
Fas. VIII. Pus ; Fas. IX. Hypertrophy. 
15*. each. 



' Mr. Chitty. 

PRACTICAL TREATISE on MEDICAL JURISPRUDENCE ; 
With all the Laws relating to Medical Practitioners, and Explanatory Notes. 
By J. Chitty, Esq. B mister at Law. 
Royal 8vo. Part I. 21s. 



Dr. Christison. 
TREATISE on POISONS, 

In relation to Medical Jurisprudence, Physiology, and the Practice -of Physic. 
By R. Christison, M.D. 8vo. 2d Edition, 18*. bd3. 



Sir C. M. Clarke. 

OBSERVATIONS on the DISORDERS of FEMALES. 

Illustrated by Plates. 
By Sir Chas. Mansfield Clarke, Bart. M.D. F.R.S. Physician in Ordinary 
to the Queen. 
t 3d Edition, 2 Vols, royal 8vo. 11. 16*. 



Mr. Clark. 

A PRACTICAL TREATISE on TEETHING, 
From Infancy to the completion of the Second Dentition, at about 24 years of Age: 
tn Four Chapters, each descriptive of an Era in the Development of the Teeth and Jaws. 
By J. Paterson Clark, M.A. 
Author of a " New System of Treating the Human Teeth." 
Svo. 3s. 



Mr. Le Gros Clark. 

THE PRACTICAL ANATOMY and ELEMENTARY PHYSIOLOGY 
of the NERVOUS SYSTEM : 
Designed for the Use of Students in the Dissecting-Room. 
By F. Le Gros Clark, Demonstrator of Anatomy in St. Thomas's Hospital. 
9s. bds. 



VALUABLE WORKS ON MEDICINE, SURGERY, ETC. 



Dr. Collins. 

A PRACTICAL TREATISE on MIDWIFERY; 

Containing the Result of Sixteen Thousand Six Hundred and Fifty-Four Births, 
occurring in the Dublin Lying-in Hospital, during a period of Seven 
Years, commencing Tsovember, 1826. 
By Robert Collins, M.D. late Master of the Institution. 
8vo. price 12s. 6d. 



Dr. Combe. 

OBSERVATIONS on MENTAL DERANGEMENT. 
By A. Combe, M.D. &c. Post 8vo. 7*. 6d. 

Dr. Conquest. 
OUTLINES of MIDWIFERY, 

Developing its Principles and Practice. 
Intended as a Text-Book for Students. By J. T. Conquest, M.D. F.L.S. 
5th Edit, with Engravings, 12mo. 7s. 6d. 

Sir Astley Cooper. 
ANATOMY and SURGICAL TREATMENT of ABDOMINAL HERNIA. 

In Two Parts. 
By Sir Astley Cooper, Bart. F.R. S. &c. 
Edited by C. Aston Key, Senior Surgeon to Guy's Hospital. 
2d Edition, in folio, with Additional Plates, 51. 5s. 

By the same Author, 
Observations on the Diseases of the Testis. 
4to. with Plates, price 31. 3s. coloured, or ll. lis. 6d. plain. 

Anatomy of the Thymus Gland. 
4to. with 5 Plates, 14s. 



Dr. Copland. 

A DICTIONARY of PRACTICAL MEDICINE. 
By J. Copland, M.D. F.R.S.&c. 
8vo. Parts 1, 2, and 3, price 9s. each. 
To form 1 thick volume, uniform with "Cooper's Surgical Dictionary.' 
By the same Author, 
Pestilential Cholera: its Nature, Prevention, and Cure. 

12mo. 5s. 



Dr. Craigie. 

ELEMENTS of GENERAL and PATHOLOGICAL ANATOMY. 
By David Craigie, M.D. 8vo. 16s. 



Dr. Cullen. 

FIRST LINES of the PRACTICE of PHYSIC. 

By W. Cullen, M.D. With an Appendix, commenced by the Author, and 
continued and completed by J. C. Gregory, M.D. F.R.S.E. &c. 
2 Vols. 8vo. 1/. 4s. 



PRINTED FOR LONGMAN, REES, AND CO. 



7 



Dr. Cutler. 

POPULAR SURGERY: 

Being plain Directions offered to the Public at large, for affording Relief in all Cases of 
Accident, and dangerous Disea>e, Poisoning, ike, 
In the absence of a regular Practitioner. 
From the French of M. Mayor. With Notes and Additions, by 
Thomas Cutler, M.D. 4s. bds. 



Dr. Thomas Davies. 



LECTURES on DISEASES of the LUNGS and HEART, 
Delivered at the Loi.don Hospital, by Thomas Davies, M.D. 
Mem. Roy. Col. Phys., &c.&c. 



Dr. Dowson. 

INTRODUCTION to the STUDY and PRACTICE of MEDICINE. 
By John Dow son, M.D. V2mo.As.Qd. 



Mr. H. Earle. 

TWO LECTURES ON THE 
PRIMARY and SECONDARY TREATMENT of BURNS. 
By Henry Earle, F.R.S. Surgeon Extraord. to the King, &c. 
With 2 Plates, 2s. 6d. 



Mr. J. W. Earle. 



NEW EXPOSITION of the FUNCTIONS of the NERVES. 
By James William Earle. 
8vo. Part I. 7s. 6d. 



Edinburgh Medic o-Chirurgical Society. 

TRANSACTIONS of the MEDICO CHIRURGICAL SOCIETY of 
EDINBURGH. 

8vo. Vol. I. with Plates, 18.y. bds.; Vol. II. 14*. bds. ; Vol. III. Parts f. and II. 12s. each. 



Dr. Elliot son. 

HUMAN PHYSIOLOGY. 

By John Elliotson, M.D. Cantab. F.R.S. 
With which is incorporated, much of the Elementary Part of the Institutiones 
Physiologic^ of J. F. Blumenbach, 
Professor in the University of Gottingen. 
5th Edit, in 8vo. with numerous Woodcuts. Part I. price \0s.6d. 
*♦* The remaining Part will appear in the course of 1836. 



Dr. Farre. 

TREATISE ON SOME 

PRACTICAL POINTS relating to the DISEASES of the EYE. 

By the late J. C Saunders. Edited by J. R. Farre, M.D. 
3d Edition, 14*. plain, and VI. 5s. coloured. 

Journal of Morbid Anatomy, &c. 
Edited by J. R. Farre, M.D. 
8vo. with Plates, Part I. 6s. 

By the same Author, 
Apology for British Anatomy. 
4to. with 2 beautiful Lithographic Illustrations, Os. plain; 12s. coloured. 



8 



VALUABLE WORKS ON MEDICINE, SURGERY, ETC. 



Mr. D. Fox. 

THE SIGNS, DISORDERS, and MANAGEMENT of PREGNANCY; 

The Treatment to be adopted during and alter Confinement; and the 
Management and Disorders of Children. 
Written expressly for the Use of Females. 
By Douglas Fox, M.R.C.S. and one of the Surgeons to the Derbyshire General Infirmary. 

8vo. 6s. 



Dr. Fyfe. 

ELEMENTS op CHEMISTRY. 
By Andrew Fyfe, M.D. F. R. S.E. 
2d Edition, comprising all the recent Discoveries. 8vo. 24*. 
By the same Author, 
Manual of Chemistry. 18mo. 7s. 

Mr. R. T. Gore. 

INTRODUCTION to the COMPARATIVE ANATOMY of ANIMALS; 

Compiled with constant reference to Physiology. 
By C. G. Carus, Med. et Phil. Doct. From the German, by R. T. Gore, M.R.C.S. 
2 Vols.Bvo. and a 4to. Vol. of 20 Plates, with References, 31. 



Dr. Gooch. 

PRACTICAL COMPENDIUM of MIDWIFERY. 

By the late Robert Gooch, M.D. 
Prepared for publication by George Skinner, M.R.C.S.L. 
12mo. 7s. 



Dr. Mason Good. 

THE STUDY "of MEDICINE. 

By John Mason Good, M.D. F.R.S. &c. 
4th Edit, improved from the Author's MSS. and by reference to the latest advances 
Physiology, Pathology, and Practice. 
By Samuel Cooper, Professor of Surgery in the London University. 
4 thick Vols. 8vo. 3/. 3s. 



Sir. S. L. Hammick. 



PRACTICAL REMARKS ON 

AMPUTATIONS, FRACTURES, and STRICTURES of the URETHRA. 

By Sir S. Love Hammick, Surgeon Extraordinary to the King,&c. 
8vo. 99. 



Dr. Harrison. 

THE DUBLIN DISSECTOR ;~~or, MANUAL of ANATOMY. 

Comprising a Description of the Bones, Muscles, Vessels, Nerves, and Viscera ; also the 
relative Anatomy of the different Regions of the Human Body j 
together with the Elements of Pathology. 
By Robert Harrison, A.M. M.B. T.C.D. &c. &c. 
12mo. price 9s. in boards, the Fourth Edition, considerably enlarged and improved. 



Dr. G. C. Holland. 

AN INQUIRY into the PRINCIPLES and PRACTICE of MEDICINE, 

founded on 

ORIGINAL PHYSIOLOGICAL INVESTIGATIONS. 
By G.Calvert Holland, M.D. 
Physician to the Sheffield General Infirmary. 
8vo. I2s. 



PRINTED FOR LONGMAN, REES, AND CO. 



Dr. Hooper. 

MEDICAL DICTIONARY; 

Containing an Explanation of the Terms in Anatomy, Botany. Chemistry, Materia Medica 
Midwifery, Mineralogy, Pharmacy, Physiology, Practice of Physic, Surgery, &c. 
By Robert Hooper, M.D. F.L.S. 
Physician to St. Marylebone Infirmary, &c. 
1 large vol. 6th Edition, 28j. 

By the same Author, 
Morbid Anatomy of the Human Brain. 

Illustrated by col'd Engravings; imp. 4to. 11. 12*. 6d. 

Morbid Anatomy of the Human Uterus and its Appendages. 
Imp. 4to. with 21 col'd Plates, 31. 3s. 



Mr. Ingleby. 

PRACTICAL TREATISE on UTERINE HEMORRHAGE, 

In connexion with Parturition. 
By John Ingleby, M.R.C.S. Lecturer on Midwifery, Birmingham. 
8vo. \'2s. 



Dr. Jewel. 

LONDON PRACTICE of MIDWIFERY: 
Including the most important Diseases of Women and Children. 
Chiefly designed for the Use of Students and early Practitioners. 
Willi Alterations and Additions, by G. Jewel, M.D. 
Senior Physician- Accoucheur to the St. George's and St. James's Dispensary ; Lecturer on 

Midwifery, &c. 
12mo. 6th edit. 6s. 6d. 



Dr. Kay. 

The PHYSIOLOGY, PATHOLOGY~ 

Including Suspended Animation in New-born Children, and from Hanging, 
Drowning, Wounrls of the Chest, &c. 
By J. P. Kay, M.D. formerly President of the Royal Med. Soc. Edinb. 
8vo.10s.6rf. 



Mr. C. Aston Key. 
MEMOIR ON THE 

ADVANTAGES and PRACTICABILITY of DIVIDING the STRICTURE 

in STRANGULATED HERNIA on the outside of the SAC. 
By C Aston Key, Surgeon to Guy's Hospital, Lecturer on Surgery, &c. 
With Cases, and 3 col'd Drawings. 7*. 6d. 



Mr. Knox. 



THE ANATOMIST'S INSTRUCTOR and MUSEUM COMPANION : 
Being Practical Directions for the Formation and subsequent Management 
of Anatomical Museums. 
By Frederick John Knox. 4s. 6d. 



Dr. Latham. 

LECTURES on SUBJECTS connected with CLINICAL MEDICINE, 

Delivered at St. Bartholomew's Hospital, by Dr. Latham. 
1 vol. 12mo. 6s. 6d. 



10 



VALUABLE WOKKS ON MEDICINE, SURGERY, ETC. 



Mr. Lee. 

AN ACCOUNT OF THE 
MOST FREQUENTED WATERING PLACES on the CONTINENT, 

And of the Medicinal Application of their Mineral Springs: 
With Tables of Analysis, and an Appendix, on the principal Mineral Waters of England. 
By Edwin Lee, M.R C.S., 
Author of Observations on the Continental Medical Institutions. 
1 vol. post 8vo. 

Mr. Liston. 

ELEMENTS OF SURGERY. 

By Robert Liston, Surgeon to the North London Hospital. 
One thick volume 8vo. 27*. The Three Parts may still be had separately, price 9*. each. 



London Medical and Chirurgical Society. 

TRANSACTIONS of the MEDICAL and CHIRURGICAL SOCIETY of 

LONDON ; 

Comprising a mass of valuable and important Papers on Medicine and Surgery. 
8vo. with Engravings. Vol. XIX. 15*. 

Mr. Lucas. 
A CONCISE 

ANATOMICAL DESCRIPTION of the ARTERIES of the HUMAN BODY 

Together with full Directions for cutting down upon and securing the 
several Arterial Trunks. 
For the Use of Students in Anatomy. 
By P. Bennett Lucas, Member of the Royal College of Surgeons, London. 
4?. 6d. bds. 



Dr. Macaulay. 
DICTIONARY of MEDICINE, 

Designed for Popular Use. 
By Alexander Macaulay, M.D. 8vo. 2d Edition, 14s. 

Dr. Macbraire. 

A SYSTEM of MEDICAL NOSOLOGY. 
By J. Macbraire, M.D. L.E., &c. &c. 5s. 

Dr. Mackenzie. 

A PRACTICAL TREATISE on DISEASES of the EYE. 

By Wm. Mackk.vzie, M.D. 
Lecturer on the Eye in the University of Glasgow. 
2d Edit, in a thick volume 8vo. with Copper-plates and above 100 Woodcuts, 25s. 

By the same Author, 
Description of the Human Muscles; with a Table of their combined 
Actions, &c. 3s. 



Dr. Mackintosh. 

ELEMENTS of PATHOLOGY and PRACTICE of PHYSIC. 

By J. Mackintosh, M.D. Acting Surgeon to the Ordnance in North Britain, &c. 
2 vols. Gvo. 3d Edit. 31s. 6d. 



PRINTED FOR LONGMAN, REES, AND CO. 



11 



Mr. Maclean. 

ILLUSTRATIONS of TEETHING; 

Or, a Treatise on the Progress and Shedding of the Human Teeth, to the completion of 
the permanent set : 
Shewing the Causes of the Irregularity and Decay of the Teeth: 
and the means most appropriate to their Preservation. 
By R. Maclean, Dentist. 
Royal 8vo. with Plates, 10*. plain, and 12*. coPd. 

M. Magendie. 

ELEMENTARY COMPENDIUM of PHYSIOLOGY, 

For the Use of Students. 
By F, Magendie, M.D. &c. 
From the French, with Notes, Tables, &c. by E. Milligan, M.D. &c. 
4th Edit, greatly enlarged, 8vo. 21*. 

Dr. Maunsell. 

THE DUBLIN PRACTICE of MIDWIFERY. 
By Henry Maunsell, M.D. Lecturer on Midwifery, &c. at the Medical School, 
Park Street, Dublin. 12mo. 5*. 

Dr. M* Cor mac. 

AN EXPOSITION OF THE 

NATURE, TREATMENT, and PREVENTION of CONTINUED FEVER. 

By Henry MTormac, M.D. M.R.C.S.E. 
In 1 vol. 8vo. 6*. 

Mr. Middlemore. 

A TREATISE ON THE 
DISEASES of the EYE and its APPENDAGES. 
By Richard Middlemore, M.R.C.S. Surgeon to the Birmingham Eye Infirmary, &c. 
In 2 thick vols.Svo. price 1Z. 15*. 

Dr. Morries Mr. Graves. 

HORTUS MEDICUS; 

Oi Figures and Descriptions of the more important Plants, either used in Medicine, or 
possessed of Poisonous Qualities, principally confined to those indigenous to 
Great Britain: with tiie Chemical Analyses, Ate. 
By George Graves, F.L.S.; and John Davie Morries, M.D. 
4to.with 44 Engravings, and numerous Wood-cuts. 30*. plain ; 42*. correctly coloured. 

Dr. Murray. 

A DISSERTATION on the INFLUENCE of HEAT and HUMIDITY ; 

With practical Observations on the Inhalation of Iodine and various Vapours, 
in Consumption, Catarrh, Croup, Asthma, and other Diseases. 
By Ja mes Murray, M.D.,&c. 
1 Vol. 10*. 6d. cloth. 

Dr. Oke. 

PRACTICAL OBSERVATIONS ON THE 
IMMEDIATE TREATMENT of the PRINCIPAL EMERGENCIES 
that occur in SURGERY and MIDWIFERY, 
Systematically arranged. 
By W. S. Oke, M.D. 
Part I. 8vo. 8s. Part II. 6s. 



12 



VALUABLE WORKS ON MEDICINE, SURGERY, ETC. 



Dr. Palmer. 

A DICTIONARY of TERMS employed by the FRENCH, 

In Anatomy, Physiology, Paiholoey, PracMcal Medicine, Surgery, Midwifery, 
Pharmacy, Medical Zoology, Botany, and Chemistry ; 
With their Derivations from the Greek and Latin ; &c. &c. &c. 
By Shirley Palmer, M.D. formerly of Tamworth. 
Parts I. and II. 65. each. To be completed in 3 Parts. 



Mr. Parkes. 

THE CHEMICAL CATECHISM. 

By the late Samuel Parkes, F.L.G. and W.S.&c. 
Author of" Chemical Essays," " Rudiments of Chemistry," &c. 
Adapted to the present state of Chemical Science, by E. W. Brayley, Jun. A.L.S., 
of the London Institution. 
8vo. 13th Edit. 155. 



Mr. Percivall. 
ANATOMY of the HORSE, 

Embracing the Structure of the Foot. 
By William Pbrcivall, M.R.CS. Veterinary Surgeon in the 1st Life Guards. 
8vo. 208. 

By the same Author, 

Hippopathology : a Systematic Treatise on the Disorders and Lameness 
of the Horse. 
With Woodcuts. 8vo. Vol. I. 10s. 6d. 

Pharmacopoeia Londinensis. 

PHARMACOPOEIA COLLEGII REGALIS MEDICORUM LONDINENSIS, 

MDCCCXXIV. 
8vo. 8s.; and lSino. 5s. 



Dr Wilson Philip. 
TREATISE on the MEANS of PRESERVING HEALTH, 

And particularly the prevention of Organic Diseases. 
By A. P. WilsoxN Philip, M.D. F.R.S.L. and E. 8vo. 12s. 



Mr. B. Phillips. 

TREATISE on the URETHRA 

Its Diseases, especially Stricture, and their Cure. 
By B.Phillips. 8vo. with 2 Plates, 8s. 

Mr. Rees. 

A TREATISE on the ANALYSIS of BLOOD and URINE, 

In Health and Disease: 
With Directions for the Analysis of Urinary Calculi. 
By G. O. Rees. 

Intended as an Introduction to Animal Analysis, for the use of the Medical Profession. 
1 vol. 8vo. 5s. 6d. 
By the same Author, translated from the French, 

The Analysis of Inorganic Bodies. By J. J. Berzelils. 12mo. 5s. 



PRINTED FOR LONGMAN, REES, AND CO. 



13 



M. Richerand. 

ELEMENTS of PHYSIOLOGY. 

By A. Richerand. 

Fifth Edition. Translated from the French, and supplied with Notes and a copious 
Appendix, by James Cop la. \ d, M.D. 
8vo.2d Edit. 18s. 

Mr. Russell. 

OBSERVATIONS on the TESTICLES. 

By James Russell, M.R.C.S. 4s. 

Mr. Sandwith. 

INTRODUCTION to ANATOMY and PHYSIOLOGY: 

For General Readers, Young Persons, and Junior Medical Students. 
By T. Sandwith, Surgeon. Plates. Is. 6rf. 

Mr. Scott. 

SURGICAL OBSERVATIONS ON THE 
TREATMENT of CHRONIC INFLAMMATION 

In various Structures; 
Particularly as exemplified in the Diseases of the Joints. 
By John Scott, Surgeon to the London Hospital, &c. 8vo. 7s. Qd. 

By the same Author, 
Cases of Tic Douloureux, and other Forms of Neuralgia. 

8vo. 2s. 6d. 

Sir Charles Scudamore. 

TREATISE on the NATURE and CURE of RHEUMATISM. 
By Sir C. Soudamore, M.D. F.R.S. 15s. 
By the same Author, 
Cases illustrating and confirming the Remedial Power of the Inhalation of 
Iodine and Conium, in Tubercular Phthisis and various 
Disorders of the Lungs. 
8vo. 2d edit. 7*- 6d. 

Treatise on the Mineral Waters of Buxton, Tunbridge Wells, Bath, 
Cheltenham, the Beulah Spa (Norwood), &c. 
2d Edition, 8s. 

Observations on Laennec's Method of forming a Diagnosis of the Diseases 
of the Chest by means of the Stethoscope. 5s. 

Treatise on the Nature and Cure of Gout and Gravel. 
Large 8vo. 4th Edit. 20s. bds. 
Further Examination of the Principles of the Treatment of Gout, 
With Observations on Colchicum. 
8vo. 2d edit. 6s. 

Essay on the Blood. 
Svo. 6s. 

Principles of the Treatment of Gout ; 
With a further Examination of the Effects of Colchicum as a Remedy ; 
And some Observations on the Use cf Veratria in that Disease. 
8vo. 2*. 6d. 

Dr. Seymour. 

ILLUSTRATIONS OF 

SOME of the PRINCIPAL DISEASES of the OVARIA, 
Their TREATMENT, &c. 
By Edward J. Seymour, M. D. 
8vo. with an Atlas of 14 Engravings in folio, 21s.; India Paper, 31s. 6d. 
By the same Author, 

Observations on the Medical Treatment of Insanity. 
8vo. 5s. 



14 VALUABLE WORKS ON" MEDICINE, SURGERY, ETC. 



Mr. Shaw. 

NATURE and TREATMENT of the various DISTORTIONS 

TO WHICH THE SPINE AND BONES OF THE CHEST ARE SUBJECT. 

By John Shaw. 8vo. 10.?. 6d. 
Dr. Southwood Smith. 

SYSTEMATIC TREATISE on FEVER. 

By Southwood Smith, M. D. Physician to the Loudou Fever Hospital. 
8vo. 14s. 

Mr. Spender. 

OBSERVATIONS ON THE 

CAUSES and TREATMENT of ULCEROUS DISEASES of the LEG. 
By J. C. Spender, M.R.C.S.L. 
1 vol. 8vo. 7s.6d. 



Mr. Stafford. 

ON PERFORATION AND DIVISION OF 
PERMANENT STRICTURE OF THE URETHRA 

BY THE LANCETTED STILETTES ; 
With Observations on the Nature and Treatment of Spasmodic and Inflammatory Stricture 
and on various other Urethral Affections. 
By R. A. Stafford, 

Surgeon to the St. Maryiebone Infirmary, Member of the Royal College of Surgeons, &c. 
8vo. Third Edition, greatly enlarged and improved, Qs. 

Mr. Stanley. 
ACCOUNT OF THE 

MODE of PERFORMING the LATERAL OPERATION of LITHOTOMY. 

By Edward Stanley, 
Lecturer on Anatomy and Physiology at St. Bartholomew's Hospital. 
Royal 4to. Plates, 15s. 

Mr. Swan. 

ILLUSTRATIONS OF THE 

COMPARATIVE ANATOMY of the NERVOUS SYSTEM. 
By Joseph Swan. 
In 4to. Part I. price 10s. 6d. 

By the same Author, 
Demonstration of the Nerves of the Human Body. 
Imp. folio, with 50 Engravings, half-b.i. russia, 14/. 

Demonstration of the Nerves of the Human Body. 
Being the whole of the foregoing work, on 25 Steel Plates, by Finden. 
In 4to. price It. lls.6d. 

Treatise on Diseases and Injuries of the Nerves. 
8vo. 14*. 



Mr. W. H. Thomas. 

THE SURGICAL AND DESCRIPTIVE 
ANATOMY of the BONES, LIGAMENTS, and JOINTS. 
By W. H. Thomas. 12mo. 6s. 

Dr. Thomas. 

MODERN PRACTICE of PHYSIC, 

Exhibiting the Character, Causes, Symptoms, Prognostics, Morbid Appearance, 
and improved Method of treating the Diseases of all Climates. 
By Robert Thomas, M.D. 
In 1 thick Vol. 8vo. 9th Edition, revised, 18s. 



PRINTED FOR LONGMAN, REES, AND CO. 



15 



Dr. A. Todd Thomson. 
ELEMENTS of MATERIA MEDICA and THERAPEUTICS ; 

Including the recent Discoveries and Analyses of Medicines. 
By A. ToddThomson, M.D. F.L.S. &c. Professor of Mat. Med. and Therapeutics, 
and of Medical Jurisprudence, in the University of London. 
1 Vol. 8vo. 21s. 

By the same Author* 

London Dispensatory; 

Containing Translations of the Pharmacopoeias, &c. &c. : forming a Practical Synopsis 
of Materia Medica, Pharmacy, and Therapeutics. 
1 large Vol. 8vo. 8th Edition, with important Additions, IS*. 

Atlas of Delineations of Cutaneous Eruptions; 
Illustrative of the Descriptions in Dr. Bateman's Practical Synopsis of 
Cutaneous Diseases. 
Royal 8vo. 29 col'd Plates, 31. 3*. 

Conspectus of the Pharmacopoeias. 
New Edit. 5s. 6d. 

Some Observations on the Preparation and Medicinal Employment of 
Ioduret and Hydriodate of Iron. 
8vo. 2s. 6d. sewed. 



Dr. Thorburn. 

ELEMENTS of BEDSIDE MEDICINE and GENERAL PATHOLOGY, 

&c. &c. 

By J. Stewart Thorburn, M.D. 8vo. 14s. 



Mr. Travers, 

A FURTHER INQUIRY CONCERNING 
CONSTITUTIONAL IRRITATION, and the PATHOLOGY of the 
NERVOUS SYSTEM. 
By Ben J. Travers, F.R.S. Senior Surgeon to St. Thomas's Hospital, &c. &c. 
8vo. 14s. 

By the same Author, 
Observations on the Pathology of Venereal Affections. 

8vo. 3s. 

Inquiry into the Process of Nature in Repairing Injuries of the Intestines. 
8vo. with Plates, 15s. 
An Inquiry concerning that Disturbed State of the Vital Functions, 
usually denominated Constitutional Irritation. 
2d Edition, revised, 8vo. 14s. 



Dr. Turnbull. 

ON THE MEDICINAL PROPERTIES of the NATURAL ORDER 

RANUNCULACEiE ; 

And more particularly on the Uses of Sabadilla Seeds, Delphinium Staphysagria, and 
Aconitum Napellus : and their Alcaloids— Veratria, Sabadilline, Delphiuia,aud Acouitine. 
By A. Turn bull, M.D. 8vo.6*. 

By the same Author, 

An Investigation into the Remarkable Medicinal Effects resulting from the 
External Application of Veratria. 

2d Edit. 8vo. 5*. 

On the Preparation and Medicinal Employment of Aconitine, 
in the Treatment of Tic Douloureux, &c. 
8vo. 3s. 6d. 



16 VALUABLE MED[CAL WORKS, PRINTED FOR LONGMAN AND CO. 



Sir George L. Tuthill. 

NEW PHARMACOPOEIA of the ROYAL COLLEGE of PHYSICIANS 
of LONDON. MDCCCXXIV. 
Translated into English. 
By Sir George L. Tuthill, Knt. M.D.F.R.S. 
8vo. 7s. ; andlSmo. 4s. 

The Translation is printed pa^e for page with the original Latin, and both may 
be had done up together. 

Mr. Waite. 

THE GUMS: 
With late Discoveries on their Structure, Growth, Connexions, Diseases, and Sympathies. 
By Mr. George Waite, Surgeon-Dentist, M.R.C.S. 
1 vol. 12mo. 6?. 

By the same Author, 
The Surgeon- Dentist's Manual. 
12mo. 5s. fid. bds. 



Mr. War drop. 

ANEURISM, and its CURE by a NEW OPERATION. 

By James Wardrop, Surgeon to his Majesty ._ 
Royal 8vo. 10s. 6d. 

Mr. White. 

COMPENDIUM of the VETERINARY ART ; 

Containing Rules for the Treatment of all the Disorders and Accidents to which the 
Horse is liable; &c. 
By J. White, late Vet. Surgeon of the 1st, or Royal Dragoons. 
15th Edit. Ss. 

By the same Author, 
Treatise on Veterinary Medicine; 
Vol. II. containing the Materia Dietetica, the Materia Medica, and the Pharmacopoeia. 
12mo. 6th Edit, considerably improved, 6s. 

Treatise on Veterinary Medicine ; 

Vol. III. containing Practical Observations on the Structure, Diseases, &c. 
of the Digestive Organs of the Horse, &c. 
8th Edit. 6s. 

Compendium of Cattle-Medicine, 

Or Practical Observations on the Disorders of Cattle and the other Domestic Animals, 
except the Horse. 
12mo. 5th Edition, 6s. 



THE LONDON MEDICAL GAZETTE: 

CONSTITUTING A 

COMPLETE AND AUTHENTIC RECORD OF MEDICAL LITERATURE. 



Published every Saturday Morning: it is also issued (with the Magazines) in Monthly 
Parts, with a full and arranged Table of Contents. 



Wilson & Son, Printers, 57, Skinner-Street, London. 



1837